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Individual

KELLY PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
1901 S CEDAR ST STE 101, TACOMA, WA 98405-2302
(253) 301-5370
Mailing address
1901 S CEDAR ST STE 101, TACOMA, WA 98405-2302

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.382825
OH
363LA2200X
Adult Health Nurse Practitioner
Primary
AP61095811
WA
363LC0200X
Critical Care Medicine Nurse Practitioner
APRN.CNP.025246
OH

Other

Enumeration date
05/08/2019
Last updated
02/23/2021
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