Mekenna Peterson, ATC, SA

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT.0001978 Issued in CO

Practice address

2150 Stadium Drive Floor 2
Boulder, CO 80309-9117

Phone

(303) 315-9900

NPI assigned

Nov 8, 2016

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1478563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1780126680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15209 W 48TH AVE",
            "city": "GOLDEN",
            "state": "CO",
            "postal_code": "804031722",
            "telephone_number": "563-580-3756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 STADIUM DRIVE FLOOR 2",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803099117",
            "telephone_number": "303-315-9900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 Inverness Dr W",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "CO",
            "postal_code": "801125065",
            "country_code": "US",
            "telephone_number": "303-694-9666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MEKENNA",
        "credential": "ATC, SA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-08",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZX2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Orthopedic Assistant",
            "state": "CO",
            "license": "20-0208",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CO",
            "license": "AT.0001978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Petersen-Hanson, PT
• Anja Keb Peterson, REGISTERED NURSE
• Devin Elizabeth Peterson
• Faye Kornfeld Peterson, L.P.C.
• Linda M. Peterson, CP
• Morgan A Peterson
• Nancy Anne Peterson, PA-C
• Tina Leanne Peterson, MA, LPCC
• Vicky Ann Peterson, LCSW
• Daniel Petitti

• Athletic Trainer in Boulder, CO
• Providers in Boulder, CO by specialty
• Athletic Trainer in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; 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.