KELLY-ANN PETERS (NPI# 1417425042) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417425042 |
| Entity Type | Individual |
| Full Name | KELLY-ANN PETERS |
| Credential | PA-C |
| Practice Address |
1211 Sherwood Park Dr Ne Ste A Gainesville GA 30501 |
| Mailing Address |
Po Box 742616 Atlanta GA 30374-2616 |
| Practice Telephone | 7702193202 |
| Practice Fax Number | 7702193209 |
| Mailing Telephone | 7702198420 |
| Mailing Fax Number | 7702198440 |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-12-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 9045 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
009045 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1242 Park Hollow Ln, Lawrenceville, GA 300433885 | 7706531092 |
| Street Address |
1211 SHERWOOD PARK DR NE STE A |
| City | GAINESVILLE |
| State | GA |
| Zip Code | 30501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558329367 | William Matthew Vassy | Surgery | 1211 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3444 | 2006-05-02 |
| 1639706583 | Travis Andrew Ford | Physician Assistant | 1211 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3444 | 2020-03-23 |
| 1265072896 | Katrina Marie Natale Parker | Registered Nurse | 1211 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3444 | 2020-01-12 |
| 1144796210 | Katie Jo Wacker | Physician Assistant | 1211 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3444 | 2018-10-16 |
| 1548749575 | Kelsey Bradford | Registered Nurse | 1211 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3444 | 2018-08-10 |
| 1710407291 | Tonya Adams Scott | Nurse Practitioner | 1211 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501 | 2017-06-26 |
| 1801248489 | Adam D. Smith | Nurse Practitioner | 1211 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3444 | 2016-07-07 |
| 1174966337 | Timothy John Stevens | Surgery | 1211 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3444 | 2013-04-08 |
| 1700166428 | Seth E. Enterline | Physician Assistant | 1211 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3444 | 2011-08-25 |
| 1295056067 | Cecil Elsmond Brown Jr. | Surgery | 1211 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3444 | 2010-06-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437782851 | Madison Raye Huth | Physician Assistant | 743 Spring Street Se, Gainesville, GA 30501 | 2020-02-13 |
| 1205487659 | Grace M Walker Brown | Nurse Practitioner | 592 Medical Park Dr., Suite A, Gainesville, GA 30501 | 2019-09-26 |
| 1174086987 | Nayab Ahmed | Student in an Organized Health Care Education/Training Program | 743 Spring Street, Suite 710, Gainesville, GA 30501 | 2019-04-09 |
| 1154881118 | Ryan D Berry | Student in an Organized Health Care Education/Training Program | 734 Spring St Se Ste 710, Gainesville, GA 30501 | 2019-03-24 |
| 1609336304 | Harper E Niver | Student in an Organized Health Care Education/Training Program | 743 Spring St., Suite 710, Gainesville, GA 30501 | 2019-03-20 |
| 1508336173 | Bradee Burrell Aderholt | Nurse Practitioner | 663 Lanier Park Drive, Gainesville, GA 30501 | 2018-11-27 |
| 1578068359 | Soammy Liz Matias | Chiropractor | 961 Green Street, Gainesville, GA 30501 | 2018-03-26 |
| 1811496896 | Matthew Brown | Speech-Language Pathologist | 500 Spring St. Se Suite 101, Gainesville, GA 30501 | 2018-02-06 |
| 1346769825 | Dr. Skeete & Associates of North Georgia, P.C. | Optometrist | 150 Pearl Nix Parkway, Suite D3a, Gainesville, GA 30501 | 2017-09-15 |
| 1932624723 | M & B Imaging, PC | Radiology | 1640 Jesse Jewell Pkwy Se Ste 2, Gainesville, GA 30501 | 2017-08-14 |
| Find all providers in zip 30501 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659806248 | Bluff Drive Medical | Physician Assistant | 954 Memorial Dr, Gainesville, GA 30501-2334 | 2017-04-21 |
| 1891085692 | Brevard Surgical Solutions L.L.C. | Physician Assistant | 11302 Nw 31st Rd, Gainesville, FL 32606-6840 | 2011-04-13 |
| 1700180627 | Julie Marie Haberski | Physician Assistant | 5630 Chestatee Landing Dr, Gainesville, GA 30506-6815 | 2011-01-06 |
| 1902853286 | Jean Dietrich Megenity | Physician Assistant | 10026 Nw 12th Ln, Gainesville, FL 32606-8017 | 2006-05-30 |
| 1366417149 | James William Becker | Physician Assistant | 200 S Enota Dr Ne Ste 360, Gainesville, GA 30501-3466 | 2006-02-23 |
| 1578547832 | Dawn M Ferrer | Physician Assistant | 1296 Sims St Ste B, Gainesville, GA 30501-3873 | 2005-12-01 |
| 1962000950 | Kelli O'shaughnessy | Physician Assistant | 1600 Sw Archer Rd, Gainesville, FL 32610-3003 | 2020-10-13 |
| 1346847944 | Nicholas Scott Duarte | Physician Assistant | 1600 Sw Archer Rd, Gainesville, FL 32610-3003 | 2020-10-06 |
| 1023643251 | Robert J Poole | Physician Assistant | 743 Spring St Ne, Gainesville, GA 30501-3899 | 2020-03-09 |
| 1912541533 | Samantha Morgan Kleiber | Physician Assistant | 1240 Jesse Jewell Pkwy Se Ste 300, Gainesville, GA 30501-3861 | 2019-11-06 |
| Find all providers in GAINESVILLE | ||||
| City | GAINESVILLE |
| Zip Code | 30501 |
Please comment or provide details below to improve the information on KELLY-ANN PETERS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.