Kevan Michael Petterson, DNP, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

61145175 Issued in WA

Practice address

901 Boren Ave Ste 1900
Seattle, WA 98104-3508

Phone

(206) 622-6444

NPI assigned

Feb 23, 2021

Last updated

Feb 23, 2021By the provider in NPPES

Sex

Male

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

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": "1614038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1942894670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2353 YALE AVE E UNIT A",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981023309",
            "telephone_number": "206-679-7167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 BOREN AVE STE 1900",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043508",
            "telephone_number": "206-622-6444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2353 Yale Ave E Unit A",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981023309",
            "country_code": "US",
            "telephone_number": "206-679-7167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTERSON",
        "first_name": "KEVAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-23",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "61145175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Petruzzella
• Jonna Petry, MA, LMHCA
• Devin Elizabeth Petschl, NP
• Caroline Maier Pettepiece, LMT, LMHCA
• Marianne Pettersen, MSW LICSW
• Gail D Petteruti, PAC
• Charles Q.S. Petteys, LMP
• Kiley A Pettiford
• Leandro Joel Pettino
• Gail Y. Pettis, DDS, MMED.SC.

• Family Nurse Practitioner in Seattle, WA
• Providers in Seattle, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 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.