Kathryn Lynn Petersen, RN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

8598-33 Issued in WI

Practice address

704 S Webster Ave Ste 501
Green Bay, WI 54301

Phone

(920) 433-6050

Fax

(920) 433-6049

NPI assigned

Jul 23, 2018

Last updated

Aug 14, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kathryn L Roethle Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1532304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534204800000",
    "number": "1235616269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S WEBSTER AVE STE 501",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-433-6050",
            "fax_number": "920-433-6049"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "744 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013505",
            "country_code": "US",
            "telephone_number": "920-433-3500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "311 N 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Sturgeon Bay",
            "state": "WI",
            "postal_code": "542352401",
            "country_code": "US",
            "telephone_number": "920-433-6050",
            "fax_number": "920-433-6049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KATHRYN",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-23",
        "last_updated": "2018-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "8598-33",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "168554-30",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "ROETHLE",
            "middle_name": "L",
            "credential": "APNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Caley Peters, RPH
• Eric J Peters, MD
• Jessica Erin Peters, CRNA
• Sarah Jane Peters
• Amber N Petersen Kuemmel, RN, CRNA
• Alexander Lee Peterson, D-PT
• Ashley M Peterson, D.P.T.
• Brett Mychael Peterson, CRNA
• Carol Jean Peterson, APNP
• Jesse Frederick Peterson, PSYD

• Nurse Practitioner in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; 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.