Provider Demographics
NPI:1750842381
Name:PETERSON, CATHERINE KELLY (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:KELLY
Last Name:PETERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:KELLY
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5711 S 1475 E STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5185
Mailing Address - Country:US
Mailing Address - Phone:801-332-9034
Mailing Address - Fax:
Practice Address - Street 1:5711 S 1475 E STE 201
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5185
Practice Address - Country:US
Practice Address - Phone:801-332-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5901190-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily