Provider Demographics
NPI:1730264987
Name:PETERSON, DENISE K (NP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:K
Last Name:PETERSON
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Gender:F
Credentials:NP
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Mailing Address - Street 1:16980 DALLAS PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1908
Mailing Address - Country:US
Mailing Address - Phone:817-461-3003
Mailing Address - Fax:817-469-6156
Practice Address - Street 1:902 W RANDOL MILL RD
Practice Address - Street 2:STE 200
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2572
Practice Address - Country:US
Practice Address - Phone:817-461-3003
Practice Address - Fax:817-275-2525
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-12-08
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Provider Licenses
StateLicense IDTaxonomies
TX52094363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187125301Medicaid
TX187125301Medicaid