Peterson, Kelsey Rose

Peterson, Kelsey Rose is an individual health care provider with primary practice located at 1245 Nw 4Th St Ste 101 , Redmond OR 97756-1680. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Peterson, Kelsey Rose can be contacted via phone (541) 548-7761.

Contact Information

Primary practice address
1245 Nw 4Th St Ste 101 Redmond OR 97756-1680
Phone: (541) 548-7761
Fax: (541) 598-3485
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA164169 Oregon

Profile Details

NPI number 1902144983
LBN Legal business name Peterson, Kelsey Rose
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 25th, 2013
Last updated Jun 1st, 2020 - about 6 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 1902144983 NPPES
Oregon MEDICAID 500670083

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