Individual
KATIE LYNNE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3151 N WINDSONG DR, PRESCOTT VALLEY, AZ 86314-2240
(928) 778-4711
Mailing address
12262 E BRADSHAW MTN RD, DEWEY, AZ 86327-6032
(928) 772-1673
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
36001348A
IN
363AM0700X
Medical Physician Assistant
Primary
6032
AZ
363AM0700X
Medical Physician Assistant
PA21714
CA
Other
Enumeration date
01/14/2007
Last updated
05/10/2017
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