DR. KEVIN PETERSEN (NPI# 1205971066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205971066 |
| Entity Type | Individual |
| Full Name | DR. KEVIN PETERSEN |
| Credential | MD |
| Practice Address |
653 N Town Center Dr Las Vegas NV 89144-0514 |
| Practice Telephone | 7022567616 |
| Practice Fax Number | 7022561481 |
| Mailing Telephone | 7022567616 |
| Mailing Fax Number | 7022561481 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 9665 | NV | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356778419 | Kevin Thomas Petersen | Surgery | 620 John Paul Jones Cir Dept General, Portsmouth, VA 23708-2197 | 2013-10-03 |
| 1457655680 | Kevin W Petersen | Marriage & Family Therapist | 1420 S Clarkson St, Denver, CO 80210-2237 | 2011-01-03 |
| 1255861126 | Kevin Scott Petersen | Physical Therapist | 3160 8th St Sw Ste M&n, Altoona, IA 50009-1023 | 2017-06-14 |
| 1356676290 | Kevin Leon Petersen | Psychologist | 6439 Garners Ferry Road, Wjbd Va Medical Center, Columbia, SC 29209 | 2009-10-09 |
| 1578759270 | Kevin Lee Petersen | Counselor | 401 16th St Se, Rochester, MN 55904-7973 | 2007-09-18 |
| 1851414346 | Kevin E. Petersen | Chiropractor | 29 Lake St S, Big Lake, MN 55309-4588 | 2007-04-09 |
| Street Address |
653 N TOWN CENTER DR |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89144-0514 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457356461 | Luis Leon Diaz | Specialist | 653 N Town Center Dr, Ste 312, Las Vegas, NV 89144-0520 | 2005-06-16 |
| 1689151326 | Latitia Joann Robinson | Social Worker | 653 N Town Center Dr, Las Vegas, NV 89144-0514 | 2018-07-25 |
| 1518418193 | Stahl Wellness Screening, P.C. | Internal Medicine | 653 N Town Center Dr, #400, Las Vegas, NV 89144-0514 | 2016-10-19 |
| 1265989800 | Laura Leigh Deleon | Nurse Practitioner | 653 N Town Center Dr, Ste. 317, Las Vegas, NV 89144-0514 | 2016-09-01 |
| 1952783920 | Mountain Podiatry | Podiatrist | 653 N Town Center Dr, Suite #118, Las Vegas, NV 89144-0514 | 2015-06-25 |
| 1477951770 | Andrew H Hwang Md Prof LLC | Urology | 653 N Town Center Dr, Suite 407, Las Vegas, NV 89144-0514 | 2014-12-18 |
| 1326479759 | Lords of Lond | Family Medicine | 653 N Town Center Dr, 114, Las Vegas, NV 89144-0514 | 2013-12-11 |
| 1972931426 | George R Mcmickle M D P C | Clinic/Center | 653 N Town Center Dr, Suite 318, Las Vegas, NV 89144-0514 | 2013-10-18 |
| 1164857488 | Maria L Burgess | Nurse Practitioner | 653 N Town Center Dr, Suite 504, Las Vegas, NV 89144-0514 | 2013-09-05 |
| 1487097739 | Muir Summerlin Pain Clinic Ltd | Pain Medicine | 653 N Town Center Dr, Suite 210, Las Vegas, NV 89144-0514 | 2013-04-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033609599 | Anila Naz | Technician | 1529 Waterton Drive, Las Vegas, NV 89144 | 2018-05-10 |
| 1467987487 | Judith L. Tan | Nurse Practitioner | Summerlin Hospital, 657 N Town Center Dr, Las Vegas, NV 89144 | 2017-04-27 |
| 1871049437 | Derek Anthony Smith | Physical Therapist | 89135, 10550 W Park Run Dr, Las Vegas, NV 89144 | 2016-09-01 |
| 1619324662 | Sydney Spoon | Dietitian, Registered | 624 Canyon Greens Dr, Las Vegas, NV 89144 | 2016-05-19 |
| 1629455985 | Md24 Nv, Inc. | Nurse Practitioner | 1180 North Town Center Dr, Ste 100, Las Vegas, NV 89144 | 2015-05-06 |
| 1053652628 | Melvin Lackey Jr. | Behavioral Analyst | 10708 Esk Dr, Las Vegas, NV 89144 | 2013-03-07 |
| 1740445667 | Jaydee R. Lumbad | Family Medicine | 1111 N Town Center Drive, Las Vegas, NV 89144 | 2008-07-21 |
| 1700053824 | Samim Enayat | Internal Medicine | 10105 Banburry Cross Dr Ste 130, Las Vegas, NV 89144 | 2008-05-08 |
| 1629252457 | Edmund Reyes Goroza | Pediatrics | 10105 Banburry Cross Dr Ste 170, Las Vegas, NV 89144 | 2007-12-28 |
| 1730375262 | H.l.greenberg M.d., Ltd. | Clinic/Center | 653 N. Town Center Drive, Ste #410, Las Vegas, NV 89144 | 2007-09-18 |
| Find all providers in zip 89144 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710503305 | Michelle Mong Chan | Specialist | 5250 S Rainbow Blvd Unit 1138, Las Vegas, NV 89118-0630 | 2020-06-19 |
| 1821627878 | Anita Sidhu | Specialist | 9916 Pipestone St, Las Vegas, NV 89141-8667 | 2020-04-02 |
| 1316571144 | Jessica Lynn Bosch | Specialist | 2452 Desert Glen Dr, Las Vegas, NV 89134-8871 | 2020-03-02 |
| 1255963229 | Samantha Muro | Specialist | 4400 S Jones Blvd Unit 1017, Las Vegas, NV 89103-3336 | 2020-02-07 |
| 1417431024 | Misnelli Diaz-osorio | Specialist | 4714 E Flamingo Rd, Las Vegas, NV 89121-4709 | 2018-09-19 |
| 1265920011 | Mike Henley | Specialist | 8220 W Charleston Blvd, Las Vegas, NV 89117-1219 | 2018-04-27 |
| 1811485691 | George Alan Wheeler | Specialist | 2750 S Durango Dr Apt 2058, Las Vegas, NV 89117-2645 | 2018-04-26 |
| 1477082261 | Stephanie Staub | Specialist | 929 Boulder Mesa Dr Unit 102, Las Vegas, NV 89128-4151 | 2017-06-06 |
| 1124562327 | Medical Massage Rehab, LLC | Specialist | 945 Falconhead Ln Unit 202, Las Vegas, NV 89128-0332 | 2016-12-07 |
| 1396296323 | Kori Jeffries | Specialist | 8625 Dollhouse Dr, Las Vegas, NV 89145-4839 | 2016-10-14 |
| Find all providers in LAS VEGAS | ||||
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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.