Kourtney Peterson

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

104671 Issued in OK

Practice address

721 W Britton Rd
Oklahoma City, OK 73114-2909

Phone

(405) 632-6688

NPI assigned

Jun 19, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Variety Care, Inc.Group PAC ID 1557260007, 101 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kpeterson376633@direct.ochin.org

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.

• Variety Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Oklahoma City, OK
  • NPI 1780697813
  Medicare reassignment Care Compare group NPD
• Variety Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Norman, OK
  • NPI 1427228352
  NPD
• Variety Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Oklahoma City, OK
  • NPI 1942045455
  NPD
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

{
    "created_epoch": "1466294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1093165227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N GRAND BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731071818",
            "telephone_number": "405-632-6688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 W BRITTON RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731142909",
            "telephone_number": "405-632-6688"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1025 Straka Ter",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731392544",
            "country_code": "US",
            "telephone_number": "405-632-6688",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KOURTNEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-19",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OK",
            "license": "104671",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "104671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jermaine Peterson, M.ED.
• Jimmie Peterson
• Jo Elle Grace Peterson, MD
• Kathy Grant Peterson, P.T.
• Kim Peterson, LADC
• Lauren Collier Peterson, PT, DPT
• Lori B Peterson, LPC
• Nicholas Scott Peterson, M.D.
• Reshicka Mone' Peterson
• Sylvester Rakeem Peterson

• Family Nurse Practitioner in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.