MRS. KAY DIANE PETERSON (NPI# 1457367690) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457367690 |
| Entity Type | Individual |
| Full Name | MRS. KAY DIANE PETERSON |
| Credential | PMHNP |
| Practice Address |
412 Sw 12th Ave Portland OR 97205-2329 |
| Mailing Address |
7056 Se Pine St Portland OR 97215-1430 |
| Practice Telephone | 5032287134 |
| Practice Fax Number | 5039442595 |
| Mailing Telephone | 5032556768 |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 363LC1500X |
Nurse Practitioner Specialization: Community Health |
093006731N6 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| X | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
093006731N6 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 069596 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568999787 | Kay Peterson | Marriage & Family Therapist | 440 Grand Ave Ste 402, Oakland, CA 94610-5063 | 2017-05-18 |
| 1073849055 | Kay Sopinski Peterson | Massage Therapist | 4330 Golf Ter, Suite 209, Eau Claire, WI 54701-4683 | 2009-10-26 |
| Street Address |
412 SW 12TH AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97205-2329 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457308587 | Cascadia Behavioral Healthcare, Inc | Clinic/Center | 412 Sw 12th Ave, Portland, OR 97205-2329 | 2006-05-26 |
| 1699045278 | Robin Robberson | Counselor | 412 Sw 12th Ave, Portland, OR 97205-2329 | 2012-01-12 |
| 1639449200 | Megan T Ednoff | Registered Nurse | 412 Sw 12th Ave, Portland, OR 97205-2329 | 2012-01-12 |
| 1639446990 | Pamela Njideka Ogbeama | Registered Nurse | 412 Sw 12th Ave, Portland, OR 97205-2329 | 2011-11-30 |
| 1689950362 | Amy Hart | Case Manager/Care Coordinator | 412 Sw 12th Ave, Portland, OR 97205-2329 | 2011-10-26 |
| 1639454747 | Elsa Renthal | Registered Nurse | 412 Sw 12th Ave, Portland, OR 97205-2329 | 2011-10-20 |
| 1770868093 | Julie Baer | Counselor | 412 Sw 12th Ave, Portland, OR 97205-2329 | 2011-10-18 |
| 1467735233 | Robert Richardson | Community Health Worker | 412 Sw 12th Ave, Portland, OR 97205-2329 | 2011-09-27 |
| 1386927150 | Cathy Kennedy | Community Health Worker | 412 Sw 12th Ave, Portland, OR 97205-2329 | 2011-09-27 |
| 1174806574 | Darrah A Buitron | Registered Nurse | 412 Sw 12th Ave, Portland, OR 97205-2329 | 2011-09-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871026062 | Leila Soltani | Dentist | 430 Sw 13th Ave Apt 2010, Portland, OR 97205 | 2017-04-05 |
| 1114374949 | Elizabeth Alire | Counselor | 1411 Sw Morrison St., Portland, OR 97205 | 2016-05-23 |
| 1508237462 | Pacific Psychology and Comprehensive Health Center | Community/Behavioral Health | 1411 Sw Morrison Ave, Suite 310, Portland, OR 97205 | 2015-10-16 |
| 1265803761 | Alana Branson | Naturopath | 1033 Sw Yamhill Street, Suite 403, Portland, OR 97205 | 2015-10-10 |
| 1720458011 | Kate Ohene | Counselor | 1411 Sw Morrison Street, Suite 310, Portland, OR 97205 | 2015-09-30 |
| 1285004671 | Christina Nannette Mendoza | Counselor | 1411 Sw Morriston Street, 310, Portland, OR 97205 | 2015-09-29 |
| 1083095947 | Patricia Burton | Registered Nurse | 1312 Sw Washinghton, Portland, OR 97205 | 2015-06-16 |
| 1649663071 | Huey Holistic | Clinic/Center | 1221 Sw Yamill, Suite 300, Portland, OR 97205 | 2015-03-10 |
| 1376952796 | Joan Kendall Ayala | Counselor | 610 Sw Alder St Ste 915, Portland, OR 97205 | 2014-08-11 |
| 1316356165 | Satheara Sin | Massage Therapist | 1033 Sw Yamhill St. #403, Portland, OR 97205 | 2014-08-06 |
| Find all providers in zip 97205 | ||||
| Taxonomy Code | 363LC1500X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063433365 | Thomas S Stewart | Nurse Practitioner | 124 Ne 181st Ave, Suite 103, Portland, OR 97230-6668 | 2006-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033190830 | Esther Eugenia Brown | Nurse Practitioner | 1165 Union St Ne, Salem, OR 97301-4693 | 2005-11-08 |
| 1427665017 | Katlin Mostue-nesbit | Nurse Practitioner | 19 Myrtle St, Medford, OR 97504-7337 | 2020-09-28 |
| 1134428378 | Andreana Marie-concetta Gentile | Nurse Practitioner | 17070 Se Mcloughlin Blvd, Milwaukie, OR 97267-4960 | 2011-03-26 |
| 1043386717 | Elizabeth L Pethtel | Nurse Practitioner | 3170 State St, Medford, OR 97504-8450 | 2006-11-27 |
| 1124065040 | Nancy Jane Reid | Nurse Practitioner | 36 Sw Nye St, Newport, OR 97365-3821 | 2006-05-31 |
| 1851372643 | Mark Corey | Nurse Practitioner | 110 Main St, Moro, OR 97039-3080 | 2005-11-08 |
Please comment or provide details below to improve the information on MRS. KAY DIANE PETERSON.
| 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.