Provider Demographics
NPI:1649982505
Name:PETERSON, CATHERINE KAYLEEN (APRN)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:KAYLEEN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 EDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-2028
Mailing Address - Country:US
Mailing Address - Phone:214-418-0191
Mailing Address - Fax:
Practice Address - Street 1:3142 HORIZON RD STE 200
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7814
Practice Address - Country:US
Practice Address - Phone:214-306-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1102197363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics