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Individual
MRS. KAY DIANE PETERSON
Active
Individual
MRS. KAY DIANE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
Primary
093006731N6
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
093006731N6
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069596
—
OR
Enumeration date
07/31/2006
Last updated
09/11/2025
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