Kent Lee Peterson, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

0261 Issued in AZ

Practice address

919 12TH PL
Suite 10
Prescott, AZ 86305-1433

Phone

(928) 776-0770

Fax

(928) 776-8991

NPI assigned

Apr 13, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: kentpeterson@direct.meditouchehr.com

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491523200000",
    "number": "1316162647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 ROLLING HILLS CIR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863036485",
            "telephone_number": "928-710-0770",
            "fax_number": "928-445-3802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 12TH PL",
            "address_2": "SUITE 10",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051433",
            "telephone_number": "928-776-0770",
            "fax_number": "928-776-8991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KENT",
        "middle_name": "LEE",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2017-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AZ",
            "license": "0261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katharina Sophia Petersen, LPC
• Peterson PT LLC
• Becky Ann Peterson, OTR
• Brek Lamont Peterson, P.T.
• Hannah B Peterson, RDH
• Sarah Peterson, DPT
• Shalena Peterson, PA-C
• Sharla J. Peterson, OTR
• Spencer Girard Peterson
• Trent M Peterson, DO

• Podiatrist in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Podiatrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2017; 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.