Kevin Leon Petersen, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

6439 Garners Ferry Road
WJBD VA Medical Center
Columbia, SC 29209

Phone

(803) 776-4000

NPI assigned

Oct 9, 2009

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)

Not enrolled

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

{
    "created_epoch": "1255046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255046400000",
    "number": "1356676290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 RED COAT LN",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292232827",
            "telephone_number": "602-790-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6439 GARNERS FERRY ROAD",
            "address_2": "WJBD VA MEDICAL CENTER",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29209",
            "telephone_number": "803-776-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KEVIN",
        "middle_name": "LEON",
        "name_prefix": "Mr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-09",
        "last_updated": "2009-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank Andrew Peters, M.D.
• Jon K Peters, FNP
• Meredith Peters
• Sahara Peters, DO
• Walter Hamilton Peters IV, M.D.
• Peterson Psychological Services, LLC
• Arsida Peterson
• Diamond Peterson, RBT
• James Lenford Peterson, PA-C
• Jericha M Peterson, LISW-CP

• Psychologist in Columbia, SC
• Providers in Columbia, SC by specialty
• Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2009; 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.