NPIMap

Individual provider Active NPI

Preston Lee Peterson, AGACNP

  • Gerontology Nurse Practitioner
  • Sparks, NV
National Provider Identifier
1801453030
Registry record updated Aug 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
822824 Issued in NV
Practice address
2385 E Prater Way Ste 302
Sparks, NV 89434-9638
Phone
(775) 356-4514
Fax
(775) 356-4991
NPI assigned
May 22, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 822824 NV Primary
Acute Care Nurse Practitioner 363LA2100X 822824 NV

Addresses

Primary practice location

2385 E Prater Way Ste 302
Sparks, NV 89434-9638

Mailing address

1155 Mill St # McM14
Reno, NV 89502-1576
Phone (775) 982-5262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190924002708 NV Practitioner - Nurse Practitioner 9739419391 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northern Nevada Medical Group LLCGroup PAC ID 7214093020, 83 clinicians

Practice addresses (Care Compare)

2385 E Prater Way
Suite 205
Sparks, NV 89434-9688
Phone (775) 356-4888

2385 E Prater Way
Suite 302
Sparks, NV 89434-9638
Phone (775) 356-4514

Hospital & facility affiliations

  • Northern Nevada Medical Center Hospital, Sparks, NV, CCN 290032
  • Renown Regional Medical Center Hospital, Reno, NV, CCN 290001
  • Banner Churchill Community Hospital Hospital, Fallon, NV, CCN 291313
  • Renown South Meadows Medical Center Hospital, Reno, NV, CCN 290049

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
822824NVMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Renown Regional Medical Center Past Accepting new patients

Organizations & group practices 2

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

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788134400000",
    "number": "1801453030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 MILL ST # MCM14",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021576",
            "telephone_number": "775-982-5262",
            "fax_number": "775-982-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2385 E PRATER WAY STE 302",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894349638",
            "telephone_number": "775-356-4514",
            "fax_number": "775-356-4991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PRESTON",
        "middle_name": "LEE",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-22",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NV",
            "license": "822824",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NV",
            "license": "822824",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparks, NV

Sources for this page

Verify at the official NPI Registry.