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: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 HOSPITAL DR
SPRUCE PINE NC
28777-8943
US

IV. Provider business mailing address

14 ACADEMY STREET
BURNSVILLE NC
28714-2902
US

V. Phone/Fax

Practice location:
  • Phone: 828-765-6101
  • Fax: 828-765-2383
Mailing address:
  • Phone: 828-536-5125
  • Fax: 828-536-5112

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: