Provider Demographics
NPI:1225438179
Name:PETERS, KAITLYN COONEY (NP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:COONEY
Last Name:PETERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1527
Mailing Address - Country:US
Mailing Address - Phone:201-401-9113
Mailing Address - Fax:
Practice Address - Street 1:37 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1527
Practice Address - Country:US
Practice Address - Phone:201-401-9113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01213000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner