Carly Lynne Peterson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

369185-4405 Issued in UT

Practice address

1033 W 450 S
Spanish Fork, UT 84660-5612

Phone

(801) 471-9201

NPI assigned

Nov 15, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Utah Valley Pediatrics L.L.C.

  • Pediatrics Physician
  • Provo, UT
  • NPI 1497812721
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1023727468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 W 450 S",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846605612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 W 450 S",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846605612",
            "telephone_number": "801-471-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CARLY",
        "middle_name": "LYNNE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-15",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "369185-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila M Perez, RN
• Jonah Perkins
• Tangi Perry, BSN
• Rhonda Peters
• Cammy Peterson
• Chad Peterson, D.O.
• Courtney Peterson, FNP-C
• Michael Warren Peterson, D.O.
• Warren Albert Peterson, D.O.
• Steel Grant Pia, LMT

• All providers in Spanish Fork, UT
• Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.