Active NPI
Phyllis G Peterson, NP
- Primary Care Nurse Practitioner
- Belle Chasse, LA
National Provider Identifier
1366703019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- 2065
- Practice address
- 103 Dr. Bowen St.
Belle Chasse, LA 70037 - Phone
- (504) 392-3392
- Fax
- (504) 392-3303
- NPI assigned
- May 30, 2012
- Last updated
- Jun 13, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 2065 | LA | Primary |
Addresses
Primary practice location
103 Dr. Bowen St.
Belle Chasse, LA 70037
Mailing address
103 Dr. Bowen St.
Belle Chasse, LA 70037
Phone (504) 392-3392
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2065 | Other | LA | 2065 |
| 2364693 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2065 | LA | MD | Primary Care Nurse Practitioner |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/98457c6b-63ef-4752-8922-1770c81bf95b/
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402617600000",
"number": "1366703019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 DR. BOWEN ST.",
"city": "BELLE CHASSE",
"state": "LA",
"postal_code": "70037",
"telephone_number": "504-392-3392",
"fax_number": "504-392-3303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 DR. BOWEN ST.",
"city": "BELLE CHASSE",
"state": "LA",
"postal_code": "70037",
"telephone_number": "504-392-3392",
"fax_number": "504-392-3303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "PHYLLIS",
"middle_name": "G",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-30",
"last_updated": "2014-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "LA",
"license": "2065",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "2065",
"identifier": "2065",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2364693",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Belle Chasse, LA
- Ochsner Clinic LLC (Ochsner Health Center - Belle Chasse)
- Katelyn Rebecca Osterbuhr, PLPC
- Robin Pannagl, LCSW-BACS
- RJ Espesor Pedroso, NP
- Suzette B Perrin, M.ED, MS
- Trinh T Pham-T
- Plaquemine Parish School Board
- Plaquemine Parish School Board
- Plaquemines Arts Health &Cultural Institute
- Plaquemines Community C.a.R.E. Centers Foundation, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.