Individual
SHALENA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3120 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 771-3704
(928) 771-0434
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
8594
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
097887
—
AZ
Enumeration date
09/24/2012
Last updated
02/17/2025
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