CAROLYN G PETERSON (NPI# 1477535334) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477535334 |
| Entity Type | Individual |
| Full Name | CAROLYN G PETERSON |
| Other Name | CAROLYN G EDEL |
| Credential | P.A. - C |
| Practice Address |
5779 E Mayo Blvd Phoenix AZ 85054-4502 |
| Practice Telephone | 4803018000 |
| Mailing Telephone | 4803018000 |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2020-09-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1874 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
1874 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | TRIWEST | 86080015085259A199 | 01 |
| AZ | RAILROAD MEDICARE | 240004028 | 01 |
| AZ | 344458 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023569696 | Carolyn N. Peterson | Dietitian, Registered | 1615 Waybridge Ln, Apt 1e, Charlotte, NC 28210-5769 | 2016-10-19 |
| 1215332846 | Carolyn Peterson | Speech-Language Pathologist | 239 Grannys Garden Rd, Libby, MT 59923-9218 | 2014-10-24 |
| 1922340157 | Carolyn Peterson | Counselor | 14623 Ne North Woodinville Way, Suite #106, Woodinville, WA 98072-8475 | 2013-03-26 |
| 1548442874 | Carolyn Ann Peterson | Psychologist | 3215 Fortune Ct, Auburn, CA 95602-9245 | 2007-11-28 |
| 1750792669 | Carolyn M Peterson | Family Medicine | 18040 Sw Lower Boones Ferry Rd Ste 304, Portland, OR 97224-7258 | 2014-05-13 |
| 1033406509 | Carolyn Peterson | Social Worker | 610 Campus Dr, Abingdon, VA 24210-2589 | 2011-07-06 |
| 1770814485 | Carolyn S Peterson | Social Worker | 2092 S Custer Rd, Monroe, MI 48161-1831 | 2010-01-20 |
| 1285802017 | Carolyn Peterson | Licensed Practical Nurse | 301 Andrews Ave, Ft. Rucker, AL 36362 | 2008-02-14 |
| Street Address |
5779 E MAYO BLVD |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85054-4502 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043219389 | Hasan Khamash | Internal Medicine | 5779 E Mayo Blvd, Phoenix, AZ 85054 | 2005-07-19 |
| 1831709393 | Sarah Jayne Refner | Nurse Practitioner | 5779 E Mayo Blvd, Phoenix, AZ 85054-4502 | 2020-08-08 |
| 1780215616 | Amy Kole | Physician Assistant | 5779 E Mayo Blvd, Phoenix, AZ 85054-4502 | 2020-01-29 |
| 1174083075 | Jee Kim | Student in an Organized Health Care Education/Training Program | 5779 E Mayo Blvd, Phoenix, AZ 85054-4502 | 2019-03-25 |
| 1902315435 | Stacie Attig | Registered Nurse | 5779 E Mayo Blvd, Phoenix, AZ 85054 | 2017-09-27 |
| 1386906667 | Rudy Rahme | Neurological Surgery | 5779 E Mayo Blvd, Phoenix, AZ 85054-4502 | 2012-06-12 |
| 1083904221 | Deborah S Dossick | Student in an Organized Health Care Education/Training Program | 5779 E Mayo Blvd, Phoenix, AZ 85054-4502 | 2011-04-08 |
| 1477863298 | Shari T Perez | Nurse Practitioner | 5779 E Mayo Blvd, Phoenix, AZ 85054 | 2010-10-14 |
| 1427367473 | Shawna Sando Boyle | Physician Assistant | 5779 E Mayo Blvd, Phoenix, AZ 85054-4502 | 2010-09-24 |
| 1851609309 | Jaime L Engholdt | Physician Assistant | 5779 E Mayo Blvd, Phoenix, AZ 85054-4502 | 2010-09-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992255301 | Stephanie Gamber | Registered Nurse | 5405 East Pinnacle Vista Drive, Phoenix, AZ 85054 | 2016-10-10 |
| 1508231960 | Deborah Elam | Acupuncturist | 5777 East Mayo Boulevard Mayo Clinic, Phoenix, AZ 85054 | 2015-12-09 |
| 1811176860 | Desert Ridge Pediatric Dentistry | Clinic/Center | 5315 E. High Street, Suite 115, Phoenix, AZ 85054 | 2007-10-26 |
| 1902968639 | Ryan David Schulze | Chiropractor | 7000 E Mayo Blvd Ste 1058, Phoenix, AZ 85054 | 2006-12-16 |
| 1477517423 | Gary Betz II Md PC | Internal Medicine | 7010 E. Chauncey Lane, Suite 145, Phoenix, AZ 85054 | 2006-04-14 |
| 1689658395 | Alice G Mccormick | Internal Medicine | 5450 East Deer Valley Drive Unit 3206, Phoenix, AZ 85054 | 2005-12-06 |
| 1770576241 | Michelle Renee Kuhn | Physician Assistant | 6950 E Chauncey Ln, Phoenix, AZ 85054 | 2005-08-30 |
| 1609869981 | Jeffrey Alan Smith | Optometrist | 18325 N Allied Way Ste 100, Phoenix, AZ 85054 | 2005-08-23 |
| 1497753750 | Rajeev Agarwal | Pediatrics | 7010 E Chauncey Ln, Suite 225, Phoenix, AZ 85054 | 2005-07-11 |
| 1740283878 | Charles J Manak | Internal Medicine | 5777 E Mayo Blvd, Phoenix, AZ 85054 | 2005-05-23 |
| Find all providers in zip 85054 | ||||
| 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 |
|---|---|---|---|---|
| 1407456585 | Chelsea Lee Townsend | Physician Assistant | 6823 S 9th Ave, Phoenix, AZ 85041-6752 | 2020-10-28 |
| 1972100949 | Amanda Alcantar | Physician Assistant | 8822 W Minnezona Ave, Phoenix, AZ 85037-1499 | 2020-10-02 |
| 1700483898 | Athena Marie Arbuckle | Physician Assistant | 3815 E Bell Rd Ste 3600, Phoenix, AZ 85032-2166 | 2020-10-02 |
| 1356957062 | Kylee Ann Lattomus | Physician Assistant | 26008 N 47th Dr, Phoenix, AZ 85083-1681 | 2020-09-17 |
| 1841801768 | Pfai Assist, Pllc | Physician Assistant | 10645 N Tatum Blvd Ste 200-556, Phoenix, AZ 85028-3068 | 2020-08-13 |
| 1285242479 | Jacob Molina | Physician Assistant | 15820 N 21st Dr, Phoenix, AZ 85023-7268 | 2020-07-14 |
| 1649898602 | Rivi Rose Sacks | Physician Assistant | 776 E Circle Rd, Phoenix, AZ 85020-4142 | 2020-07-07 |
| 1942828876 | Taylor Leblanc | Physician Assistant | 2150 W Alameda Rd Unit 1343, Phoenix, AZ 85085-1941 | 2020-07-07 |
| 1730707746 | Emily Jane Foley | Physician Assistant | 4650 N Central Ave Unit 241, Phoenix, AZ 85012-1076 | 2020-07-07 |
| 1841815230 | Alyssa Nicole Bruns | Physician Assistant | 4217 E Altadena Ave, Phoenix, AZ 85028-2232 | 2020-06-10 |
| Find all providers in PHOENIX | ||||
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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.