Individual provider · Type 1 NPI
Kay Diane Peterson, PMHNP
Community Health Nurse Practitioner · Portland, OR
NPI number
1457367690
Active
Practice location
412 SW 12th Ave
Portland, OR 97205-2329
Fax (503) 944-2595
Mailing address
7056 SE Pine St
Portland, OR 97215-1430
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 093006731N6 (OR) |
| Community Health Nurse Practitioner Primary | 363LC1500X | 093006731N6 (OR) |
Community Health Nurse Practitioner: Definition to come...
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About NPI 1457367690
Kay Diane Peterson, PMHNP's National Provider Identifier is 1457367690, issued on Jul 31, 2006. The primary taxonomy on file is Community Health Nurse Practitioner (363LC1500X), and the practice location is in Portland, OR. The record was last updated on Sep 11, 2025.