Kierstin Petersen, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

49296874405 Issued in UT

Practice address

15 S 1000 E Ste 300
Payson, UT 84651-5592

Phone

(801) 354-8225

NPI assigned

Oct 12, 2015

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1295106581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN: CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S 1000 E STE 300",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846515592",
            "telephone_number": "801-354-8225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "972 N 600 E",
            "address_purpose": "LOCATION",
            "city": "Spanish Fork",
            "state": "UT",
            "postal_code": "846601306",
            "country_code": "US",
            "telephone_number": "801-465-4896",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "568 S Main St",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "UT",
            "postal_code": "847544400",
            "country_code": "US",
            "telephone_number": "435-527-8866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KIERSTIN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-12",
        "last_updated": "2023-11-27",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "49296878900",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "49296874405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Revere Health PC",
            "address_1": "15 S 1000 E Ste 300",
            "city": "Payson",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846515592",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Payson Sports & Spine LLC
• Pearl Care Inc (central utah pathology)
• Carsen David Penrod
• Samantha Perdue
• Perfect Balance Counseling & Consulting LLC
• Jonathan Paul Peterson, M.D.
• Heather Phelps
• Madelyn Adele Pierson
• Megan Porter
• Private Healthcare Facilities

• Family Nurse Practitioner in Payson, UT
• Providers in Payson, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.