Individual
MACKENZIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
536 W 4TH AVE, GARNETT, KS 66032-1355
(785) 448-2674
(785) 448-3091
Mailing address
PO BOX 309, GARNETT, KS 66032-0309
(785) 448-2674
(785) 448-3091
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-31228
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104817
BLUE CROSS
KS
01
—
7240801
AETNA
—
Enumeration date
07/12/2006
Last updated
07/08/2007
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