Amanda Petersen, FNP-BC, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

58323 Issued in ID

Practice address

775 Pole Line Rd W Ste 113
Twin Falls, ID 83301-5819

Phone

(208) 814-8292

NPI assigned

May 9, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525824000000",
    "number": "1689163222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W STE 113",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015819",
            "telephone_number": "208-814-8292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W STE 113",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015819",
            "telephone_number": "208-814-8292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "AMANDA",
        "credential": "FNP-BC, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-09",
        "last_updated": "2018-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "58323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas J Perius, PA
• Logan Perkins, DO
• Michael Jake Perrin, NP
• Personal Home Care Specialists LLC
• Haaris Pervaiz, MD
• Brendan Petersen, CRNA
• Kenneth Ryan Petersen, DPT, CSCS
• Scott Trevor Petersen, PHARMD
• Winston N Petersen, PA-C
• Kirk C Peterson, MD

• Family Nurse Practitioner in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.