Peterson, Kay Diane

Peterson, Kay Diane is an individual health care provider with primary practice located at 412 Sw 12Th Ave , Portland OR 97205-2329. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Community Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Peterson, Kay Diane can be contacted via phone (503) 228-7134.

Contact Information

Primary practice address
412 Sw 12Th Ave Portland OR 97205-2329
Phone: (503) 228-7134
Fax: (503) 944-2595
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 093006731N6 Oregon
Physician Assistants & Advanced Practice Nursing Providers / Community Health 363LC1500X 093006731N6 Oregon

Profile Details

NPI number 1457367690
LBN Legal business name Peterson, Kay Diane
Credentials PMHNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 31st, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457367690 NPPES
Oregon MEDICAID 069596

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