Patti Jo Peterson-Balliet, RN CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP3772 Issued in AZ

Practice address

4137 N 108TH Ave
Phoenix, AZ 85037-5459

Phone

(623) 772-7842

NPI assigned

Sep 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Registered Nurse

State licenses

Practice roles

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.

• Desert Valley Pediatrics

  • Pediatrics Physician
  • Phoenix, AZ
  • NPI 1336354984
  NPD (past)
• Pleasant Pediatrics

  • Pediatrics Physician
  • Phoenix, AZ
  • NPI 1134580970
  NPD (past)
• Pleasant Pediatrics PLC

  • Pediatrics Physician
  • Glendale, AZ
  • NPI 1376921106
  NPD (past)

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1932201795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4137 N 108TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375459",
            "telephone_number": "623-877-7337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4137 N 108TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375459",
            "telephone_number": "623-772-7842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9059 W Lake Pleasant Pkwy",
            "address_2": "E-540",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853828336",
            "country_code": "US",
            "telephone_number": "623-322-3380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON-BALLIET",
        "first_name": "PATTI",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "RN CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "20030451",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "AP3772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige D Petersen, AU.D.
• Patricia Diane Petersen
• Ryan Petersen, RBT
• Scott Richard Petersen, M.D.
• Tayler Sierra Petersen, SLPA
• Alice Ruth Peterson, P.A.-C.
• Alison M Peterson, PA-C
• Beverly A Peterson, LNA
• Caleb Eldon Peterson, M.S., CCC-SLP
• Carolyn G Peterson, P.A. - C

• All providers in Phoenix, AZ
• Pediatric Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.