Kristy Lynn Petersen, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D12087 Issued in MN

Practice address

10150 City Walk Dr Apt C
Woodbury, MN 55129-9270

Phone

(651) 714-5555

NPI assigned

Sep 29, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515542400000",
    "number": "1407948060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10150 CITY WALK DR APT C",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551299270",
            "telephone_number": "651-714-5555",
            "fax_number": "651-714-9005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10150 CITY WALK DR APT C",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551299270",
            "telephone_number": "651-714-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KRISTY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-29",
        "last_updated": "2018-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "5884015",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Missy Young Perry, MA, LMFT
• Sarah Kathleen Perryman, A.T.C.
• Renee Jean Persson, PTA
• Mary Perzel, PT
• Sally Nicole Peters, DDS, MS
• Lars Petersen, PT, DPT
• Rebecca J Petersen, DDS
• Bradley Peterson
• Christopher Peterson, PHARMD
• Donna Ellena Peterson, MA LP

• Dentist in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2018; 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.