Provider Demographics
NPI:1083918551
Name:PETERSON, KRISTEN NOEL (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:NOEL
Last Name:PETERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 E HAZELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3435
Mailing Address - Country:US
Mailing Address - Phone:602-228-2812
Mailing Address - Fax:
Practice Address - Street 1:9250 N 3RD ST STE 3025
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2428
Practice Address - Country:US
Practice Address - Phone:602-944-4628
Practice Address - Fax:602-944-2805
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily