Individual
MRS. KELSEY ROSE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1315 NW 4TH ST STE A, REDMOND, OR 97756-1328
(541) 548-7761
(541) 598-3485
Mailing address
520 MEDICAL CENTER DR, STE 300, MEDFORD, OR 97504-4316
(541) 930-8907
(541) 245-4820
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA164169
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500670083
—
OR
Enumeration date
01/25/2013
Last updated
10/17/2025
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