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General NPI Number Information
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NPI Number | 1669017315
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Entity Type | Individual
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Provider Name | TRISH R PETERSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 2210 BARRON RD STE 112
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-1908
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Country | US
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Telephone | 573-785-0889
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Fax | 573-785-2011
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Provider Business Mailing Address
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Address Line | PO BOX 801143
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City | KANSAS CITY
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State | MO
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Zip | 64180-1143
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Country | US
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Telephone | 573-331-5583
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Fax | 573-331-5079
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2019036575
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License Number State | MO
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