Healthcare Provider Details

I. General information

NPI: 1649973504
Provider Name (Legal Business Name): BAHTYA TAL PETERSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 HOSPITAL DR
CLYDE NC
28721-8026
US

IV. Provider business mailing address

490 HOSPITAL DR
CLYDE NC
28721-8026
US

V. Phone/Fax

Practice location:
  • Phone: 828-246-6372
  • Fax: 828-246-6371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-02805
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: