Kari Lee Peterson, DENTIST DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D12255 Issued in MN

Practice address

4140 Theilman Lane
Suite 208
St Cloud, MN 56301

Phone

(320) 252-4126

Fax

(320) 202-6507

NPI assigned

Dec 6, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205995594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4140 THEILMAN LANE",
            "address_2": "SUITE 208",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "56301",
            "telephone_number": "320-252-4126",
            "fax_number": "320-202-6507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4140 THEILMAN LANE",
            "address_2": "SUITE 208",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "56301",
            "telephone_number": "320-252-4126",
            "fax_number": "320-202-6507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KARI",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "DENTIST DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID",
            "identifier": "8397078",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie Louise Peterson, CRNA
• Dennis L Peterson, M.D.
• Holly Christine Peterson, MD, SFHM
• Jennifer Peterson, LMFT
• Jon B Peterson, D.C.
• Mandy Jo Peterson
• Matthew J Peterson, LMFT
• Michelle Joan Peterson, RN CAGNP
• Nicole E Peterson, P.T.
• Paul Charles Peterson, MD

• Dentist in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.