NPIMap

Organization Active NPI

Peterson Psychiatric Services, LLC

  • Psychiatric/Mental Health Registered Nurse
  • Avon, IN
National Provider Identifier
1174055438
Registry record updated Mar 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X
License
71006558A Issued in IN
Legal business name
PETERSON PSYCHIATRIC SERVICES, LLC
Practice address
4265 E Main St
Avon, IN 46123-9174
Phone
(317) 268-6555
NPI assigned
Mar 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2017

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

Authorized official

Name
Brooke Peterson, APRN
Title
Aprn
Phone
(317) 268-6555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WP0808X 71006558A IN Primary

Addresses

Primary practice location

4265 E Main St
Avon, IN 46123-9174

Mailing address

4265 E Main St
Avon, IN 46123-9174
Phone (317) 268-6555

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490659200000",
    "number": "1174055438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4265 E MAIN ST",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461239174",
            "telephone_number": "317-268-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4265 E MAIN ST",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461239174",
            "telephone_number": "317-268-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON PSYCHIATRIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-28",
        "last_updated": "2017-03-28",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_title_or_position": "APRN",
        "authorized_official_telephone_number": "317-268-6555",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71006558A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; 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.