KGP LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP60443753 Issued in WA

Legal business name

KGP LLC

Doing business as

Kerry Peterson FNP

Practice address

319 E Pioneer Ave
Montesano, WA 98563-4601

Phone

(360) 249-1980

NPI assigned

Mar 10, 2014

Organization subpart

No

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

Authorized official

Name

Kerry Peterson, FNPNPI 1790109825

Title

Owner

Phone

(360) 249-1980

Specialties & licenses 1

Addresses

Other names 1

• Kerry Peterson FNP Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kerry G Peterson, ARNP, FNP-C

  • Family Nurse Practitioner
  • Elma, WA
  • NPI 1790109825
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394409600000",
    "number": "1073939427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1898",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985200315",
            "telephone_number": "360-637-9263",
            "fax_number": "360-637-8732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 E PIONEER AVE",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985634601",
            "telephone_number": "360-249-1980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KGP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-10",
        "last_updated": "2014-03-10",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "KERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-249-1980",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60443753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kerry Peterson FNP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mikaila Ann Johnson, OTR
• Sara Eileen Johnson
• Bessie Jones
• Alethea Marie Keith-Pyhala, LMHC, CMHS
• Larry Neil Kelly, D.C.
• Marina Kuran, LMHC
• Larsen, DDS-Blanchard, DMD, PS (Broadway Dental Center)
• Russell M Larsen, DDS
• Cymbre Renee Lauing
• Michael W Lawr, DDS

• Family Nurse Practitioner in Montesano, WA
• Providers in Montesano, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.