Individual
KYRIE ALLISON PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5693 YMCA PARK DR W, FORT WAYNE, IN 46835-3280
(260) 469-6603
(260) 486-6123
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71012788A
IN
Other
Enumeration date
06/28/2022
Last updated
10/17/2022
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