MS. REKETTA PETERSON (NPI# 1972006435) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972006435 |
| Entity Type | Individual |
| Full Name | MS. REKETTA PETERSON |
| Practice Address |
3875 Geist Rd Ste E190 Fairbanks AK 99709-3564 |
| Mailing Address |
1423 Peger Rd Fairbanks AK 99709-5169 |
| Practice Telephone | 8449422434 |
| Mailing Telephone | 9079711300 |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2020-09-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
164379 | AK | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
APC006265 | GA | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1423 Peger Rd, Fairbanks, AK 997095169 | 9073711300 |
| Street Address |
3875 GEIST RD STE E190 |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99709-3564 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255946810 | Beacon Monitoring Professional Services | Technician, Other | 745 Staffordshire Rd, Fairbanks, AK 99709 | 2020-09-10 |
| 1235629544 | Fairbanks Healing Space | Health Educator | 3875 Geist Road, Suite E #136, Fairbanks, AK 99709 | 2018-05-11 |
| 1609395409 | Shawn K Goggins | Counselor | 1423 Peger Road, Fairbanks, AK 99709 | 2017-09-12 |
| 1710433347 | Jay Titus | Technician/Technologist | 2884 Marina Drive, Fairbanks, AK 99709 | 2016-09-01 |
| 1710391610 | Hannah Summerfelt | Dentist | 3539 Thomas St, Fairbanks, AK 99709 | 2014-06-18 |
| 1629407325 | Diane Louise Mitchell | Nurse Practitioner | 4650 Harvard Cir, Fairbanks, AK 99709 | 2013-11-04 |
| 1407147929 | Christina Martz | Counselor | 1270 Summet Drive, Fairbanks, AK 99709 | 2011-05-02 |
| 1255652285 | Surgery Center of Fairbanks LLC | Clinic/Center | 2310 Peger Road, Fairbanks, AK 99709 | 2010-06-14 |
| 1962661835 | John Leo Hughes Jr Jr. | Dentist | 3437 Airport Way, Suite 205, Fairbanks, AL 99709 | 2008-06-05 |
| 1508042417 | Katherine E Johnson, Md PC | Ophthalmology | 2485 Chief William Drive, Suite 100, Fairbanks, AK 99709 | 2008-01-10 |
| Find all providers in zip 99709 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629583653 | Lynn H Hoffman | Counselor | 1182 Crown Rd, Fairbanks, AK 99709-2519 | 2017-12-13 |
| 1467838847 | Solomon Porch LLC | Counselor | 626 2nd St Ste 101, Fairbanks, AK 99701-3466 | 2015-08-07 |
| 1215325477 | Sunrise Counseling & Therapy Service LLP | Counselor | 626 2nd St Ste 303, Fairbanks, AK 99701-3466 | 2014-12-22 |
| 1790183176 | Sally Jane Rall | Counselor | 3406 Adler Ave, Fairbanks, AK 99703 | 2014-12-16 |
| 1417274101 | Laurey Gronemeier | Counselor | 1340 Gull Rd, Fairbanks, AK 99712-1223 | 2010-04-21 |
| 1942364112 | David B Bates | Counselor | 122 10th Avenue, Fairbanks, AK 99701 | 2006-12-21 |
| 1053494898 | Terry Kelly | Counselor | 1716 University Ave S, Fairbanks, AK 99709-4904 | 2006-10-23 |
| 1174546519 | Karin Gillis | Counselor | 1403 Joliet Dr, Fairbanks, AK 99709-6746 | 2006-07-26 |
| 1720052137 | Joni Simpson | Counselor | 1405 Kellum St, Fairbanks, AK 99701-4102 | 2006-02-14 |
| 1023631983 | Timothy Ledna | Counselor | 3100 S Cushman St, Fairbanks, AK 99701-7516 | 2020-05-26 |
| Find all providers in FAIRBANKS | ||||
Please comment or provide details below to improve the information on MS. REKETTA 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.