Provider Demographics
NPI:1487014338
Name:PETERSON, KERRY ANN (PHD, DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHD, DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13120 E 19TH AVE # C288-5
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2567
Mailing Address - Country:US
Mailing Address - Phone:303-724-1362
Mailing Address - Fax:
Practice Address - Street 1:13120 E 19TH AVE # C288-5
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2567
Practice Address - Country:US
Practice Address - Phone:303-724-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990196-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health