Healthcare Provider Details

I. General information

NPI: 1023590007
Provider Name (Legal Business Name): AUBREY PETERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E 23RD AVE
HUTCHINSON KS
67502-1105
US

IV. Provider business mailing address

1701 E 23RD AVE
HUTCHINSON KS
67502-1105
US

V. Phone/Fax

Practice location:
  • Phone: 620-665-2000
  • Fax:
Mailing address:
  • Phone: 620-665-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: