Healthcare Provider Details

I. General information

NPI: 1437624459
Provider Name (Legal Business Name): KAREN PETERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 STARDUST RD UNIT 3
BURNSVILLE NC
28714-6385
US

IV. Provider business mailing address

56 STARDUST RD UNIT 3
BURNSVILLE NC
28714-6385
US

V. Phone/Fax

Practice location:
  • Phone: 828-203-8820
  • Fax: 855-576-5013
Mailing address:
  • Phone: 828-203-8820
  • Fax: 855-576-5013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011085
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: