Provider Demographics
NPI:1669864492
Name:PETERSON, RACHAEL
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 COLLEGE BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2192
Mailing Address - Country:US
Mailing Address - Phone:913-777-0077
Mailing Address - Fax:877-796-6309
Practice Address - Street 1:8625 COLLEGE BLVD
Practice Address - Street 2:STE 103
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2192
Practice Address - Country:US
Practice Address - Phone:913-777-0077
Practice Address - Fax:877-796-6309
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily