Peterson, Timothy Warren

Peterson, Timothy Warren is an individual health care provider with primary practice located at 85 N Grand Ave , Fort Thomas KY 41075-1793. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Peterson, Timothy Warren can be contacted via phone (859) 572-3617.

Contact Information

Primary practice address
85 N Grand Ave Fort Thomas KY 41075-1793
Phone: (859) 572-3617
Fax: (859) 572-2326
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA1799 Kentucky

Profile Details

NPI number 1720388218
LBN Legal business name Peterson, Timothy Warren
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 30th, 2010
Last updated Jul 30th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720388218 NPPES
Kentucky MEDICAID 7100252800

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