Kay Diane Peterson, PMHNP

Primary specialty

Community Health Nurse PractitionerTaxonomy code 363LC1500X

License

093006731N6 Issued in OR

Practice address

412 SW 12TH Ave
Portland, OR 97205-2329

Phone

(503) 228-7134

Fax

(503) 944-2595

NPI assigned

Jul 31, 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

Other identifiers 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": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1457367690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7056 SE PINE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151430",
            "telephone_number": "503-255-6768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 SW 12TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052329",
            "telephone_number": "503-228-7134",
            "fax_number": "503-944-2595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KAY",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "093006731N6",
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "OR",
            "license": "093006731N6",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "069596",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Peterson
• Julie M. Peterson, PMHNP
• Kathryn Peterson
• Katlyn Rene Peterson, OD
• Katy Celeste Peterson
• Kimberly Nicole Peterson, M.A.
• Leah Peterson, CNM
• Lindsey Louise Peterson, PA-C
• Lucy Rose Peterson, CADC II, QMHA-R
• Matthew Peterson

• Community Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Community Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.