| Doctor Name: | KIZZY HARGETT PETERSEN |
| NPI Number: | 1457732414 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 5007734 |
| Business Practice Address: | 203 North St Bayboro, NC - 285150010 |
| Business Phone Number: | 2527455111 |
| Business Fax Number: | 2527457684 |
| Mailing Address: | 203 North St, BAYBORO |
| State: | NC |
| Postal Code: | 285150010 |
| Phone Number: | 2527455111 |
| Fax Number: | 2527457684 |
| NPI Enumeration Date: | 06/16/2015 |
| NPI Last Update Date: | 07/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SC1501X |
| License Number: | 5007734 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Community Health/Public Health |
| Taxonomy Definition: | |