Molly Petersen, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

111672 Issued in NE

Practice address

17670 Welch PLZ Ste 102
Omaha, NE 68135-3805

Phone

(402) 403-5222

Fax

(402) 403-5233

NPI assigned

Jun 19, 2014

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

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 1

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Camp-Grimit Petersen LLCGroup PAC ID 2264701598, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Camp-Grimit Petersen LLC

  dba Collaborative Psych Practitioners

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bennington, NE
  • NPI 1922532324
  Medicare reassignment Care Compare group NPD Authorized official
• Associated Counseling Professionals PC

  • Mental Health Counselor
  • Omaha, NE
  • NPI 1386661189
  Medicare reassignment NPD
• Father Flanagan's Boys Home

  dba Boys Town Center for Behavioral Health

  • Psychologist
  • Boys Town, NE
  • NPI 1265405419
  NPD (past)
• Lotus Psychotherapy, LLC

  • Clinical Social Worker
  • Omaha, NE
  • NPI 1952838005
  NPD (past)

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1679987432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12077 ELMWOOD DR.",
            "city": "BENNINGTON",
            "state": "NE",
            "postal_code": "68007",
            "telephone_number": "402-332-7648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17670 WELCH PLZ STE 102",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681353805",
            "telephone_number": "402-403-5222",
            "fax_number": "402-403-5233"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2255 S 132nd St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681442573",
            "country_code": "US",
            "telephone_number": "402-334-1122",
            "fax_number": "402-334-8171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MOLLY",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NE",
            "license": "111672",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NE",
            "license": "111672",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NE",
            "license": "111672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirstin Petersen
• Leah Petersen
• Matthew D. Petersen, S.T.
• Melissa Petersen
• Mickaelle Petersen, MSW, LMHP
• Nikki Petersen
• Rachelle Petersen, APRN
• Samuel Petersen
• Sarah C Petersen
• Scott Petersen, ED.S.

• Psychiatric/Mental Health Nurse Practitioner in Omaha, NE
• Providers in Omaha, NE by specialty
• Psychiatric/Mental Health Nurse Practitioner in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.