MR. KENNETH S PETERSON (NPI# 1194744896) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194744896 |
| Entity Type | Individual |
| Full Name | MR. KENNETH S PETERSON |
| Credential | NP |
| Practice Address |
26 Queen St Worcester MA 01610 |
| Mailing Address |
26 Queen Street Worcester MA 01610-2473 |
| Practice Telephone | 5088607800 |
| Practice Fax Number | 5088607973 |
| Mailing Telephone | 5088607800 |
| Mailing Fax Number | 5088607973 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2018-07-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN192039 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 0322938 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 116 Belmont St, Suite 11, Worcester, MA 016052964 | 5083341102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871565788 | Kenneth A Peterson | Optometrist | 911 Oak Park Blvd Ste 104, Pismo Beach, CA 93449-3406 | 2006-02-03 |
| 1386131324 | Kenneth D Peterson | Nurse Anesthetist, Certified Registered | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2018-04-16 |
| 1912140351 | Kenneth Brian Peterson | Internal Medicine | 8757 E Bell Rd, Scottsdale, AZ 85260-1322 | 2009-04-15 |
| 1164646741 | Kenneth Roy Peterson | Chiropractor | 76 Fort Hill Rd, Groton, CT 06340-4333 | 2007-04-13 |
| 1386768265 | Kenneth Dean Peterson | Chiropractor | 1002 W Elm Ave, Hermiston, OR 97838-2711 | 2007-03-18 |
| 1083706659 | Kenneth B Peterson | Family Medicine | 113 Comanche Rd, Fort Meade, SD 57741-1002 | 2006-09-29 |
| 1053321497 | Kenneth L Peterson | Dentist | 165 Nw 1st Ave, John Day, OR 97845-1101 | 2006-08-08 |
| 1144287707 | Kenneth P Peterson | Anesthesiology | 15910 Ventura Blvd, Suite 1502, Encino, CA 91436-2802 | 2006-04-27 |
| Street Address |
26 QUEEN ST |
| City | WORCESTER |
| State | MA |
| Zip Code | 01610 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669460051 | Philip Joseph Bolduc | Family Medicine | 26 Queen St, Family Practice 3, Worcester, MA 01610-2473 | 2005-10-10 |
| 1013517341 | Erich Berantuo | Registered Nurse | 26 Queen St, Worcester, MA 01610-2473 | 2020-10-27 |
| 1366070419 | Stephany Giraldo Eierle | Student in an Organized Health Care Education/Training Program | 26 Queen St, Worcester, MA 01610-2473 | 2020-04-01 |
| 1225666969 | Henry J Louis | Student in an Organized Health Care Education/Training Program | 26 Queen St, Worcester, MA 01610-2473 | 2020-03-30 |
| 1497383467 | Katherine Elizabeth Price | Student in an Organized Health Care Education/Training Program | 26 Queen St, Worcester, MA 01610-2473 | 2020-03-27 |
| 1295377802 | Esther N Miwanda | Registered Nurse | 26 Queen St, Worcester, MA 01610-2473 | 2019-10-15 |
| 1598306417 | David James Goodrich II | Registered Nurse | 26 Queen St, Worcester, MA 01610-2473 | 2019-10-02 |
| 1972151496 | Kathryn Jean Devinney | Nurse Practitioner | 26 Queen St, Worcester, MA 01610-2473 | 2019-08-28 |
| 1104478288 | David Dinh | Nurse Practitioner | 26 Queen St, Worcester, MA 01610-2478 | 2019-07-10 |
| 1831741917 | Lisa Figueiredo | Registered Nurse | 26 Queen St, Worcester, MA 01610-2473 | 2019-07-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881189355 | Amber Hall | Counselor | 26 Queen St, 6th Floor, Worcester, MA 01610 | 2018-06-27 |
| 1417401951 | Kelsey Moran | Counselor | 1 College Street, Box D, Worcester, MA 01610 | 2016-08-13 |
| 1245685809 | Walter Trisdale | Specialist/Technologist | One College St., College of The Holy Cross, Worcester, MA 01610 | 2016-05-02 |
| 1669866430 | Shannon Smith | Student in an Organized Health Care Education/Training Program | 26 Queen St, Ground Floor, Ambulatory Psychiatry Service, Ummmc, Worcester, MA 01610 | 2015-03-19 |
| 1063815348 | Terri Boettcher | Social Worker | 72 Jacques Street, Worcester, MA 01610 | 2014-10-01 |
| 1700222866 | Kalynn Lucashensky | Occupational Therapist | 105 Woodland St. Apt. A, Worcester, MA 01610 | 2013-05-16 |
| 1093053993 | Chrissy Marie Ryan | Registered Nurse | 26 Queen St 6th Floor, Flow Pact, Worcester, MA 01610 | 2013-01-28 |
| 1851681324 | Renaissance Adult Day Care, LLC | Clinic/Center | 1040 Southbridge Street, Worcester, MA 01610 | 2011-04-18 |
| 1912203217 | Goddard/homestead | Custodial Care Facility | 10 Homestead Avenue, Worcester, MA 01610 | 2011-02-03 |
| 1912173196 | Rahman Ullah | Dentist | Park Ave Dental Center, 456 Park Avenue, Worchester, MA 01610 | 2008-05-07 |
| Find all providers in zip 01610 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508479593 | Belina Pupi | Nurse Practitioner | 3 Mabelle St, Worcester, MA 01602-2017 | 2020-08-28 |
| 1457996704 | Augusta Oluremi Ishola | Nurse Practitioner | 17 Nizam Dr, Worcester, MA 01605-4017 | 2019-11-11 |
| 1891346854 | Phoebe Ofosua Amoako | Nurse Practitioner | 63 Frank St Apt 97, Worcester, MA 01604-1091 | 2019-09-21 |
| 1295390227 | Irene Acheampong | Nurse Practitioner | 2 Pineland Ave Apt 9a, Worcester, MA 01604-1473 | 2019-05-06 |
| 1538660386 | Viana Bernard | Nurse Practitioner | 363 Belmont St, Worcester, MA 01604-1011 | 2018-02-27 |
| 1598137663 | Kristen Marie Haviland | Nurse Practitioner | 180 Vernon St, Worcester, MA 01610-2036 | 2015-10-28 |
| 1801233127 | Rachel N Derry | Nurse Practitioner | 358 Shrewsbury St, Worcester, MA 01604 | 2013-05-28 |
| 1902145287 | Virginia Haddad | Nurse Practitioner | 10 Crillon Rd, Worcester, MA 01605-2308 | 2013-02-06 |
| 1073858981 | Heidi Glover | Nurse Practitioner | 55 Lake Ave North Dept. of Pedi-adolescent, Ummc University Campus, Worcester, MA 01655 | 2012-12-04 |
| 1497083984 | Amy Kristen Aviles | Nurse Practitioner | 3 Aster Pl, Worcester, MA 01603-2201 | 2009-11-23 |
| Find all providers in WORCESTER | ||||
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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.