Provider Demographics
NPI:1396116620
Name:PETERS, AMY (CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N PICKAWAY ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1447
Mailing Address - Country:US
Mailing Address - Phone:740-420-8736
Mailing Address - Fax:
Practice Address - Street 1:210 SHARON RD STE B2
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1498
Practice Address - Country:US
Practice Address - Phone:740-420-8354
Practice Address - Fax:740-420-8358
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18235363L00000X
OHRN.287629.1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0152517Medicaid