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General NPI Number Information
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NPI Number | 1538585021
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Entity Type | Individual
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Provider Name | KAYLA MAE PETERSEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/09/2014
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 82 PATTON AVE STE 510
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City | ASHEVILLE
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State | NC
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Zip | 28801-3343
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Country | US
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Telephone | 828-398-5244
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Fax |
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Provider Business Mailing Address
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Address Line | 548 W 2ND AVE
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City | COLUMBUS
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State | OH
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Zip | 43201-3361
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Country | US
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Telephone | 740-418-7507
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 3275
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License Number State | WV
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