United States Air Force

Primary specialty

Military HospitalTaxonomy code 286500000X

License

RN114749 Issued in AZ

Legal business name

UNITED STATES AIR FORCE

Practice address

7219 N Litchfield Rd
Luke AFB, AZ 85309-1529

Phone

(623) 856-9725

Fax

(623) 856-7567

NPI assigned

Aug 25, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Patti Jo Peterson-Balliet, CPNP

Title

Pediatric Nurse Practitioner

Phone

(626) 536-4774

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720071608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2407 N 127TH LN",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853236576",
            "telephone_number": "623-536-4774",
            "fax_number": "623-856-7567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7219 N LITCHFIELD RD",
            "city": "LUKE AFB",
            "state": "AZ",
            "postal_code": "853091529",
            "telephone_number": "623-856-9725",
            "fax_number": "623-856-7567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED STATES AIR FORCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON-BALLIET",
        "authorized_official_first_name": "PATTI",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "PEDIATRIC NURSE PRACTITIONER",
        "authorized_official_telephone_number": "626-536-4774",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPNP"
    },
    "taxonomies": [
        {
            "code": "286500000X",
            "taxonomy_group": "",
            "desc": "Military Hospital",
            "state": "AZ",
            "license": "RN114749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING LICENSE",
            "identifier": "RN114749",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Anthony Tenn, PA-C
• Umesh Kumar Tiwari, MD
• Megan Tran, PHARMD
• Cheng Chung Tsai, R.PH
• Ralph Edward Umali, DDS
• Brendan Wadlow
• Joseph Gerard Weaver, BS PHARMACY
• Kimberly A Whipple, PHARMD
• Richard Allan Williams, MD
• Monte Scott Wilson

• Military Hospital in Luke AFB, AZ
• Providers in Luke AFB, AZ by specialty
• Military Hospital in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.