Kevin Bradley Peterson, AU.D

Primary specialty

AudiologistTaxonomy code 231H00000X

License

LD60889235 Issued in WA

Practice address

21911 76TH Ave W Ste 211
Edmonds, WA 98026-7918

Phone

(425) 775-6651

NPI assigned

Sep 25, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538697600000",
    "number": "1215412317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21911 76TH AVE W STE 211",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267918",
            "telephone_number": "425-775-6651",
            "fax_number": "425-670-6718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21911 76TH AVE W STE 211",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267918",
            "telephone_number": "425-775-6651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KEVIN",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "AU.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-25",
        "last_updated": "2018-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "WA",
            "license": "LD60889235",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WA",
            "license": "LD60889235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2108044",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anne Pesenson, MD
• Paul E. Pesheck, MD
• D. Sarah Peterson, L.I.C.S.W.
• Emily Nel Peterson, MD
• Jennifer Peterson, M.D.
• Joseph Petrin, M.D.
• Nhi Pham
• An D Phan
• Melissa Phares
• PHD#2 of Snohomish County

• Audiologist in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Audiologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; 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.