Provider Demographics
NPI:1942894670
Name:PETTERSON, KEVAN MICHAEL (DNP, FNP)
Entity Type:Individual
Prefix:DR
First Name:KEVAN
Middle Name:MICHAEL
Last Name:PETTERSON
Suffix:
Gender:M
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 YALE AVE E UNIT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3309
Mailing Address - Country:US
Mailing Address - Phone:206-679-7167
Mailing Address - Fax:
Practice Address - Street 1:901 BOREN AVE STE 1900
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3508
Practice Address - Country:US
Practice Address - Phone:206-622-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61145175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily