Individual
EMILY PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
395200 W 2900 RD, OCHELATA, OK 74051-2463
(918) 535-6000
Mailing address
11208 W 50TH ST, SHAWNEE, KS 66203-1547
(913) 238-7424
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4779
OK
Other
Enumeration date
06/27/2021
Last updated
06/09/2022
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