Millie Williams Petersen, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0942 Issued in WV

Practice address

119 Main St W
Suite a
Oak Hill, WV 25901-2943

Phone

(304) 465-0544

Fax

(304) 465-8832

NPI assigned

Apr 6, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292889600000",
    "number": "1972565653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 MAIN ST W",
            "address_2": "SUITE A",
            "city": "OAK HILL",
            "state": "WV",
            "postal_code": "259012943",
            "telephone_number": "304-465-0544",
            "fax_number": "304-465-8832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 MAIN ST W",
            "address_2": "SUITE A",
            "city": "OAK HILL",
            "state": "WV",
            "postal_code": "259012943",
            "telephone_number": "304-465-0544",
            "fax_number": "304-465-8832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MILLIE",
        "middle_name": "WILLIAMS",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2010-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "0942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0084786001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Pennington
• Amy Perdue
• Kimberly D Perkins
• Petersen Clinic, PLLC
• Bruce Norman Petersen, DO
• Ernestine NMN Phillips, R,D,LD
• Holly Phillips
• Misty Phillips
• Pamela Phillips
• Tonyia Phillips

• Family Medicine Physician in Oak Hill, WV
• Providers in Oak Hill, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.