| Peterson Wellness Primary Care And Pediatrics, Pllc | |
|
109 W Commercial St Broken Arrow OK 74012-4012 | |
| (918) 724-3952 | |
| Not Available |
| Full Name | Peterson Wellness Primary Care And Pediatrics, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 109 W Commercial St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Ashton Danielle Peterson (NURSE PRACTITIONER, OWNER) |
| Authorized Official Contact | 9187243952 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peterson Wellness Primary Care And Pediatrics, Pllc 9701 Spring Lake Dr Broken Arrow OK 74014-3426 Ph: (918) 724-3952 | Peterson Wellness Primary Care And Pediatrics, Pllc 109 W Commercial St Broken Arrow OK 74012-4012 Ph: (918) 724-3952 |
| NPI Number | 1851062517 |
|---|---|
| Provider Enumeration Date | 09/22/2021 |
| Last Update Date | 09/22/2021 |
| Medicare PECOS PAC ID | 3173919149 |
|---|---|
| Medicare Enrollment ID | O20220331001944 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851062517 | NPI | - | NPPES |
| 200833910A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Ashton Danielle Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992263453 PECOS PAC ID: 1355683798 Enrollment ID: I20190503001429 |
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