Active NPI
Karlyn M Peterson, CNM
- Advanced Practice Midwife
- River Falls, WI
National Provider Identifier
1205892098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- 148929
- Practice address
- 1687 E Division St
River Falls, WI 54022-1571 - Phone
- (715) 425-6701
- NPI assigned
- Apr 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 10075 | MN | |
| Advanced Practice Midwife | 367A00000X | 148929 | WI | Primary |
Addresses
Primary practice location
1687 E Division St
River Falls, WI 54022-1571
Mailing address
1687 E Division St
River Falls, WI 54022-1571
Phone (715) 425-6701
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07-01404 | Other | MN | MEDICA |
| 480607700 | Medicaid | MN | |
| 164365 | Other | MN | UCARE |
| 46G41PE | Other | MN | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10075 | MN | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482796800000",
"number": "1205892098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1687 E DIVISION ST",
"city": "RIVER FALLS",
"state": "WI",
"postal_code": "540221571",
"telephone_number": "715-425-6701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1687 E DIVISION ST",
"city": "RIVER FALLS",
"state": "WI",
"postal_code": "540221571",
"telephone_number": "715-425-6701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KARLYN",
"middle_name": "M",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-21",
"last_updated": "2016-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "MN",
"license": "10075",
"primary": false
},
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "WI",
"license": "148929",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "07-01404",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "480607700",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "164365",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "46G41PE",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in River Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.