Kathy L Petersburg, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

J073230 Issued in IA

Practice address

901 Montgomery St
Decorah, IA 52101-2325

Phone

(563) 382-2911

Fax

(563) 387-3102

NPI assigned

Jun 13, 2005

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 2

Medicare fee-for-service enrollment

Enrolled in IA, MN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kpetersburg114738@uihcdirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Winneshiek Medical Center

  • Critical Access Hospital
  • Decorah, IA
  • NPI 1619922051
  Medicare reassignment NPD
• Winneshiek Medical Center

  • Multi-Specialty Clinic/Center
  • Decorah, IA
  • NPI 1992854863
  Medicare reassignment NPD
• Winneshiek Medical Center

  • Primary Care Clinic/Center
  • Mabel, MN
  • NPI 1093857393
  Medicare reassignment NPD
• Winneshiek Medical Center

  • Community/Retail Pharmacy
  • Decorah, IA
  • NPI 1104507060
  NPD

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421884800000",
    "number": "1508860974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2253 MADISON RD",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521017813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MONTGOMERY ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012325",
            "telephone_number": "563-382-2911",
            "fax_number": "563-387-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSBURG",
        "first_name": "KATHY",
        "middle_name": "L",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-13",
        "last_updated": "2015-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "0696743-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "J073230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "838721400",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1432070",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yarrow Pasche, TLMHC
• Lisbeth Ann Peirce, LMHC
• Paul D Pellett, MD
• Peter J. Blodgett, DDS
• Peter P. Appell, O.D.,P.C.
• Cynthia B Peterson, MA, LISW
• Kayla Peterson
• David Liam Pittman, EMT
• Connie Lynn Popenhagen, MSW, LISW, ACADC
• Erin Marie Powers Daley, M.A., CADC

• Family Nurse Practitioner in Decorah, IA
• Providers in Decorah, IA by specialty
• Family Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.