Xavier Deon Peterson, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN323385 Issued in GA

Practice address

260 Northern Ave
Avondale Estates, GA 30002-1214

Phone

(716) 322-9408

NPI assigned

Feb 26, 2024

Last updated

Feb 26, 2024By the provider in NPPES

Sex

Male

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

Registered Nurse

State licenses

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

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1184480444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 REDWOOD ST",
            "city": "PORT GIBSON",
            "state": "MS",
            "postal_code": "391502593",
            "telephone_number": "716-322-9408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 NORTHERN AVE",
            "city": "AVONDALE ESTATES",
            "state": "GA",
            "postal_code": "300021214",
            "telephone_number": "716-322-9408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "XAVIER",
        "middle_name": "DEON",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN323385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Murray, COUNSELOR
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• Julia Rizzo, PSY.D.
• Afsoon Sanei, LCSW

• Registered Nurse in Avondale Estates, GA
• Providers in Avondale Estates, GA by specialty
• Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.