Tia Peterson, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

324961-4405 Issued in UT

Practice address

435 N Gateway Dr Ste 801
Providence, UT 84332-9004

Phone

(435) 787-1023

Fax

(435) 787-1882

NPI assigned

Oct 15, 2015

Last updated

Mar 3, 2023By the provider in NPPES

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

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Daniel J Huff Podiatry DPM PCGroup PAC ID 5597857029, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Daniel J Huff Podiatry DPM PC

  dba Foot & Ankle Center of Cache Valley

  • Foot & Ankle Surgery Podiatrist
  • Providence, UT
  • NPI 1750580643
  Medicare reassignment Care Compare group NPD
• Eric C Chenworth D.O.P.C

  dba Wasatch Allergy and Asthma

  • Allergy & Immunology Physician
  • Riverton, UT
  • NPI 1376887927
  Medicare reassignment

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

{
    "created_epoch": "1444867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1902277908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 N GATEWAY DR STE 801",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329004",
            "telephone_number": "435-787-1023",
            "fax_number": "435-787-1882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 N GATEWAY DR STE 801",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329004",
            "telephone_number": "435-787-1023",
            "fax_number": "435-787-1882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TIA",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-15",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "324961-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charity Samantha Pearson, RBT
• Rachel Perkins
• Conner Peterson, RBT
• Joshua Allen Peterson, RBT
• Sarah Lynn Peterson, RBT
• Whitney Petterborg, RDN
• Sherrie Petty
• Camille Porter
• Primrose Home Care Inc.
• Primrose Hospice Inc.

• Family Nurse Practitioner in Providence, UT
• Providers in Providence, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.