Kendra Petersen, is a
Student In An Organized Health Care Education/training Program based in Minneapolis, Minnesota. Kendra Petersen is licensed to practice in * (Not Available) (license number ) and his current practice location is
2211 Riverside Avenue South, Campus Box 149, Minneapolis, Minnesota. He can be reached at his office (for appointments etc.) via phone at
(612) 330-1399.
NPI number for Kendra Petersen is 1417840166 and his current mailing address is 2211 Riverside Avenue South, Campus Box 149, Minneapolis, Minnesota. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1417840166.
Provider's Profile
| Full Name | Kendra Petersen |
|---|
| Gender | Male |
|---|
| Speciality | Student In An Organized Health Care Education/training Program |
|---|
| Location | 2211 Riverside Avenue South, Minneapolis, Minnesota |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1417840166
- Provider Enumeration Date: 06/02/2025
- Last Update Date: 06/02/2025
Medical Identifiers
Medical identifiers for Kendra Petersen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1417840166 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kendra Petersen is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kendra Petersen,
2211 Riverside Avenue South, Campus Box 149,
Minneapolis, MN 55454
Ph: (612) 330-1399 | Kendra Petersen,
2211 Riverside Avenue South, Campus Box 149,
Minneapolis, MN 55454
Ph: (612) 330-1399 |
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