Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP60293083 | WA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95018282 | CA |
NPI | 1003152364 |
---|---|
Provider Name | Kaylee Petersen |
First Address | Seattle, WA 98145-5095 |
Second Address | San Diego, CA 92103-9000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2012 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003152364 | (05) | WA |