Healthcare Provider Details

I. General information

NPI: 1033353032
Provider Name (Legal Business Name): EMILY K PETERSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E LAKE MEAD PKWY STE 102
HENDERSON NV
89015-6443
US

IV. Provider business mailing address

3325 RESEARCH WAY
CARSON CITY NV
89706-7913
US

V. Phone/Fax

Practice location:
  • Phone: 702-868-0327
  • Fax: 702-868-0290
Mailing address:
  • Phone: 702-222-9902
  • Fax: 702-323-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO1689
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: