| Doctor Name: | KERRY PETERSON |
| NPI Number: | 1790109825 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP, FNP-C |
| License Number: | AP60443753 |
| Business Practice Address: | 319 E Pioneer Ave Montesano, WA - 985634601 |
| Business Phone Number: | 3602491980 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1898, ABERDEEN |
| State: | WA |
| Postal Code: | 985200315 |
| Phone Number: | 3606379263 |
| Fax Number: | 3606378732 |
| NPI Enumeration Date: | 02/10/2014 |
| NPI Last Update Date: | 02/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP60443753 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |