Provider Demographics
NPI:1346363694
Name:PETERSON, KARI JOSEPHINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KARI
Middle Name:JOSEPHINE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KARI
Other - Middle Name:JOSEPHINE
Other - Last Name:DAVISSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2963 E COPPER POINT DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9055
Mailing Address - Country:US
Mailing Address - Phone:208-322-8515
Mailing Address - Fax:208-322-1731
Practice Address - Street 1:2963 E COPPER POINT DR
Practice Address - Street 2:SUITE 150
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9055
Practice Address - Country:US
Practice Address - Phone:208-322-1730
Practice Address - Fax:208-322-1731
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD183336207P00000X
NMMD2009-0568207P00000X
IDM-11248207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine