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NPI Code Detail

MEDICARE: KELLEY ANN PETERSON P.A.-C.

MEDICARE: KELLEY ANN PETERSON P.A.-C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant01571IA

General Provider Information

NPI Number : 1477555886
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLEY ANN PETERSON P.A.-C.
Provider Business Mailing Address
First Line : 13682 LAKE SHORE DR
Second Line :
City : CLIVE
State : IA
Zip : 50325-8640
Country : US
Telephone Number : 515-277-8900
Fax Number : 515-223-7361
Provider Business Practice Location Address
First Line : 6000 UNIVERSITY AVE
Second Line : SUITE 310
City : WEST DES MOINES
State : IA
Zip : 50266-8203
Country : US
Telephone Number : 515-277-8900
Fax Number : 515-223-7361
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/08/2007

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Directions to “ KELLEY ANN PETERSON P.A.-C.” Practice Location

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