Provider Demographics
NPI:1316043664
Name:PETERSON, MOYA C (ARNP)
Entity Type:Individual
Prefix:
First Name:MOYA
Middle Name:C
Last Name:PETERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-1944
Mailing Address - Fax:913-588-2496
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 4017
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-1944
Practice Address - Fax:913-588-2496
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100248630BMedicaid
KS412690OtherFIRSTGUARD
MO424843506Medicaid
MO26926013OtherBCBS KANSAS CITY
500008548OtherRAILROAD MEDICARE
MO26926013OtherBCBS KANSAS CITY
KS100248630BMedicaid