Healthcare Provider Details

I. General information

NPI: 1407837727
Provider Name (Legal Business Name): IVEY G PETERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IVEY PETERSON PA-C

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 GABEL RD STE 100
BILLINGS MT
59102-7389
US

IV. Provider business mailing address

4611 POWMER RD
BILLINGS MT
59105-5050
US

V. Phone/Fax

Practice location:
  • Phone: 406-601-8001
  • Fax: 406-609-4446
Mailing address:
  • Phone: 406-927-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number70240
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: