MRS. KELSEY ROSE PETERSON (NPI# 1902144983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902144983 |
| Entity Type | Individual |
| Full Name | MRS. KELSEY ROSE PETERSON |
| Other Name | MS. KELSEY ROSE YOUNG |
| Credential | PA-C |
| Practice Address |
1245 Nw 4th St Ste 101 Redmond OR 97756-1680 |
| Mailing Address |
520 Medical Center Dr Ste 300 Medford OR 97504-4316 |
| Practice Telephone | 5415487761 |
| Practice Fax Number | 5415983485 |
| Mailing Telephone | 5419308907 |
| Mailing Fax Number | 5412454820 |
| Enumeration Date | 2013-01-25 |
| Last Update Date | 2020-06-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA164169 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500670083 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 520 Medical Center Dr, Suite 300, Medford, OR 975044334 | 5412826559 | 5412826710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396069712 | Kelsey Peterson | Dentist | 1312 South Washington Street, Emmett, ID 83617 | 2010-03-15 |
| 1942813126 | Kelsey Lin Peterson | Social Worker | 5698 W Glen Eagle Dr, West Valley City, UT 84128-4013 | 2020-08-26 |
| 1174084008 | Kelsey Rae Peterson | Pharmacist | 800 Rose St Rm H110, Lexington, KY 40536-0293 | 2019-03-25 |
| 1639658479 | Kelsey Peterson | Physician Assistant | 900 W Norfolk Ave, Norfolk, NE 68701-5006 | 2018-08-13 |
| 1003393604 | Kelsey Peterson | Nurse Practitioner | 816 22nd Ave Ste 100, Kearney, NE 68845-2226 | 2018-07-26 |
| 1659894855 | Kelsey Peterson | Occupational Therapist | 118 N 7th Ave, Sheldon, IA 51201-1235 | 2017-07-19 |
| 1932653219 | Kelsey Peterson | Dietitian, Registered | 6046 Cornerstone Ct W, Suite 226, San Diego, CA 92121-4758 | 2016-08-04 |
| 1033281019 | Kelsey Carl Peterson Jr. | Specialist | 17742 Beach Blvd, 245, Huntington Beach, CA 92647-6818 | 2006-11-14 |
| Street Address |
1245 NW 4TH ST STE 101 |
| City | REDMOND |
| State | OR |
| Zip Code | 97756-1680 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306808142 | Suzanne E Browning-tarbet | Physician Assistant | 1245 Nw 4th St Ste 101, Redmond, OR 97756-1680 | 2006-04-05 |
| 1669851606 | Kenneth Adam Conklin | Physician Assistant | 1245 Nw 4th St Ste 101, Redmond, OR 97756-1680 | 2015-05-22 |
| 1639519440 | Samuel Garbus | Surgery | 1245 Nw 4th St Ste 101, Redmond, OR 97756-1680 | 2013-06-26 |
| 1265752166 | Marques S Johnson | Surgery | 1245 Nw 4th St Ste 101, Redmond, OR 97756-1680 | 2010-06-03 |
| 1952501678 | Ngocthuy Thi Hughes | Specialist | 1245 Nw 4th St Ste 101, Redmond, OR 97756-1680 | 2007-07-20 |
| 1649228131 | John C Land | Specialist | 1245 Nw 4th St Ste 101, Redmond, OR 97756-1680 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679083349 | Vicki Rae Morris | Foster Care Agency | 3585 Sw 35th St., Redmond, OR 97756 | 2017-10-06 |
| 1275066417 | Norco, Inc | Durable Medical Equipment & Medical Supplies | 655 Nw Jackpine Ave, Redmond, OR 97756 | 2017-04-05 |
| 1750778015 | Kelly Gobler | Occupational Therapy Assistant | 3000 Sw 32nd Street, The Heights Assisted Living, Redmond, OR 97756 | 2015-04-23 |
| 1912303934 | Andrea Adams | Pharmacist | 944 Sw Veterans Way, Redmond, OR 97756 | 2014-11-18 |
| 1649670365 | Advantage Dental Clinics LLC | Dentist | 442 Sw Umatilla Ave., Suite 200, Redmond, OR 97756 | 2014-08-29 |
| 1760891832 | Elizabeth Mae Smith | Counselor | 2659 Sw 4th St Ste 102, Redmond, OR 97756 | 2014-08-04 |
| 1700296837 | Heather A Ahlf | Physician Assistant | 1245 Nw Canal Blvd, Redmond, OR 97756 | 2014-04-29 |
| 1306289277 | Asa Racquel Aramburo | Social Worker | 203 Sw 8th St., Redmond, OR 97756 | 2013-04-10 |
| 1427396969 | Alison Elizabeth Jackson | Pharmacist | 944 Sw 9th Street, Redmond, OR 97756 | 2013-01-17 |
| 1083964449 | Julie C Plachta | Mechanotherapist | 654 Nw 4th Street, Redmond, OR 97756 | 2012-09-13 |
| Find all providers in zip 97756 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831790591 | Bailey Mantha-nagrant | Physician Assistant | 7912 170th Ave Ne Unit 301, Redmond, WA 98052-0907 | 2020-11-07 |
| 1003471590 | Calli Elizabeth Prestwood | Physician Assistant | 3818 Sw 21st Pl Ste 201, Redmond, OR 97756-6801 | 2019-05-09 |
| 1104393933 | Robin Lynn Atkins | Physician Assistant | 16425 Ne 91st St Apt 10, Redmond, WA 98052-3695 | 2018-10-30 |
| 1700296837 | Heather A Ahlf | Physician Assistant | 1245 Nw Canal Blvd, Redmond, OR 97756 | 2014-04-29 |
| 1821151309 | Billie Lynn Cartwright | Physician Assistant | 340 Nw 5th St Ste 340nw5th, Redmond, OR 97756-1869 | 2006-12-18 |
| 1427051713 | Colleen Anastasia O'sullivan | Physician Assistant | 1253 Nw Canal Blvd, Redmond, OR 97708 | 2005-05-31 |
| 1821640491 | Heena N Patel | Physician Assistant | 2217 152nd Ave Ne Ste 100, Redmond, WA 98052 | 2019-07-12 |
| 1457851586 | Desert Bone & Joint Specialists LLP | Physician Assistant | 1315 Nw 4th St, Redmond, OR 97756 | 2018-02-15 |
| 1295248805 | Emily Suzanne Tanner | Physician Assistant | 18100 Ne Union Hill Rd, Redmond, WA 98052-3330 | 2017-11-06 |
| 1053869685 | Christine Goodall | Physician Assistant | 18100 Ne Union Hill Rd Ste 200, Redmond, WA 98052 | 2016-09-12 |
| Find all providers in REDMOND | ||||
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| 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.