Individual
TIMOTHY WARREN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
605 MAN O WAR BOULEVARD, UNION, KY 41091-2007
(859) 578-5669
(859) 384-0091
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 903-0268
(859) 428-1444
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1799
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100252800
—
KY
Enumeration date
10/30/2010
Last updated
10/27/2025
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