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General NPI Number Information
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NPI Number | 1609414168
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Entity Type | Organization
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Legal Business Name | PETERSON HEALTHCARE LLC
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 540 S LAHOMA AVE
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City | NORMAN
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State | OK
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Zip | 73069-5526
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Country | US
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Telephone | 580-235-1657
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Fax |
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Provider Business Mailing Address
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Address Line | 540 S LAHOMA AVE
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City | NORMAN
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State | OK
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Zip | 73069-5526
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Country | US
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Telephone | 580-235-1657
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER / OWNER
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Name | BRADEN PETERSON
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Credential | APRN- CNP
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Telephone | 580-235-1657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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