Provider Demographics
NPI:1134857360
Name:PETERSON, KENDALL KRISTINE (APRN- NP)
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:KRISTINE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:APRN- NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S 16TH ST STE 405
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3793
Mailing Address - Country:US
Mailing Address - Phone:402-750-3018
Mailing Address - Fax:
Practice Address - Street 1:2222 S 16TH ST STE 405
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3793
Practice Address - Country:US
Practice Address - Phone:402-481-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114336363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care