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Individual
KELLY PETERSON
Active
Individual
KELLY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
NULL
363L00000X
Nurse Practitioner
Primary
1130715
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124390253
DOD ID
—
Enumeration date
07/14/2020
Last updated
09/16/2024
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