MEDICARE: DR. KERRY ANN PETERSON PHD, DNP, PMHNP-BC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0990196-NP	CO

General Provider Information

NPI Number	:	1487014338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY ANN PETERSON PHD, DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	13120 E 19TH AVE # C288-5
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80045-2567
Country	:	US
Telephone Number	:	303-724-1362
Fax Number	:

Provider Business Practice Location Address
First Line	:	13120 E 19TH AVE # C288-5
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80045-2567
Country	:	US
Telephone Number	:	303-724-1362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2016
Last Update Date	:	03/17/2018

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