Active NPI
Kyle Peterson
- Social Worker
- Magna, UT
National Provider Identifier
1780210559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 11358625-3502
- Practice address
- 8265 W 2700 S
Magna, UT 84044-1323 - Phone
- (702) 701-3117
- NPI assigned
- Mar 12, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 11358625-3502 | UT | Primary |
Addresses
Primary practice location
8265 W 2700 S
Magna, UT 84044-1323
Mailing address
8265 W 2700 S
Magna, UT 84044-1323
Phone (702) 701-3117
Electronic endpoints 3
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Vistatc.com | ||
| Other URL | Vistatc.com | ||
| Other URL | Vistatc.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11358625-3502 | UT | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583971200000",
"number": "1780210559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8265 W 2700 S",
"city": "MAGNA",
"state": "UT",
"postal_code": "840441323",
"telephone_number": "702-701-3117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8265 W 2700 S",
"city": "MAGNA",
"state": "UT",
"postal_code": "840441323",
"telephone_number": "702-701-3117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KYLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-12",
"last_updated": "2020-03-12",
"certification_date": "2020-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "UT",
"license": "11358625-3502",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Vistatc.com",
"affiliation": "N",
"address_1": "8265 W 2700 S",
"city": "Magna",
"state": "UT",
"country_code": "US",
"postal_code": "840441323",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Vistatc.com",
"affiliation": "N",
"address_1": "8265 W 2700 S",
"city": "Magna",
"state": "UT",
"country_code": "US",
"postal_code": "840441323",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Vistatc.com",
"affiliation": "N",
"address_1": "8265 W 2700 S",
"city": "Magna",
"state": "UT",
"country_code": "US",
"postal_code": "840441323",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Magna, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.