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Contact Information

MARY T CARR PETERSON, PA
1410 SW TRADITION DR STE 110
ANKENY, IA50023
 Phone: 515-875-9696
 Fax: 515-875-9697
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for MARY T CARR PETERSON · (Female)

NPI Number 1164496212
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 02/15/2006
Last updated 08/07/2025 - About 10 months ago
Sole proprietor 1 No
Identifiers
  • IA License # 001597
  • IA Medicaid 0634600
  • IA Medicaid 1117994
  • IA Medicaid 2117994
  • IA Medicaid 3117994
  • Other 37902 WELLMARK
  • Other 37903 WELLMARK
  • Other 37904 WELLMARK
  • Other 37905 WELLMARK
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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