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DEREK PETERSEN PA-C
NPI 1104365113
Physician Assistant in Ogden, UT

Active since February 23, 2017
2240 ADAMS AVE, OGDEN, UT 84401(801) 393-5355 Get Directions Write a Review

NPPES record last updated: February 3, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 3, 2026, Feb 23, 2017 (2 updates tracked since 2017).

About Derek Petersen Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEREK PETERSEN PA-C (NPI 1104365113) is an individual physician assistant in Ogden, Utah, licensed in Utah (10232646-1206) and active in the NPI registry since February 2017. He maintains a secondary practice location in Washington Terrace.

NPPES Registry Identity

NPI1104365113
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameDEREK PETERSENCredential: PA-C
Location Address2240 ADAMS AVEOgden, UT 84401-1511
Mailing Address2240 Adams AveOgden, UT 84401-1511 · (801) 393-5355 · Fax (801) 394-4609
Phone(801) 393-5355
Sole ProprietorNo
Enumeration DateFebruary 23, 2017
Last NPPES UpdateFebruary 3, 20262 updates tracked since enumeration
NPPES CertifiedFebruary 3, 2026
✔ NPI 1104365113 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in UT · 10232646-1206
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
2240 ADAMS AVE, Ogden, UT 84401
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Secondary Practice Location 1

Location 15285 S 400 E Ste AWashington Terrace, UT 84405-7194 · Phone (801) 334-0048 · Fax (833) 428-8406

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Imperial Health Plan of the Southwest, Inc., Molina Healthcare and more.Insurance ›

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARANDA LEBRECHT PA-C
Physician Assistant
2240 ADAMS AVE
OGDEN, UT 84401
Weber County (801) 393-5335
SAGE RYLANT UKENA APRN
Nurse Practitioner (Family)
2240 ADAMS AVE
OGDEN, UT 84401
Weber County (801) 393-5355
ALEX SUAREZ LCSW
Social Worker
2240 ADAMS AVE
OGDEN, UT 84401
Weber County (801) 393-5355
KENNETH ALLEN GARCIA PA-C
Physician Assistant (Surgical)
2240 ADAMS AVE
OGDEN, UT 84401
Weber County (801) 393-5355
JESSICA ESTRADA
Social Worker (Clinical)
2240 ADAMS AVE
OGDEN, UT 84401
Weber County (801) 393-5355
MR. TY JOO MCCOMAS FNP-C
Nurse Practitioner (Family)
2240 ADAMS AVE
OGDEN, UT 84401
Weber County (801) 393-5355
KATHRYN EVANS
Physician Assistant
2240 ADAMS AVE
OGDEN, UT 84401
Weber County (801) 393-5355
MATTHEW JACKSON PA-C, MPAS
Family Medicine
2240 ADAMS AVE
OGDEN, UT 84401
Weber County (801) 393-5355

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derek Petersen's NPI number?

The NPI number for Derek Petersen is 1104365113. It was assigned to this individual provider in the NPPES registry on February 23, 2017.

Where is Derek Petersen located?

Derek Petersen practices at 2240 Adams Ave, Ogden, UT 84401. The listed phone number is (801) 393-5355.

What is Derek Petersen's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

What insurance does Derek Petersen accept?

Health plans from BridgeSpan Health Company, Imperial Health Plan of the Southwest, Inc., Molina Healthcare, Regence BlueCross BlueShield of Utah and University of Utah Health Plans list Derek Petersen as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Derek Petersen was last updated on February 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.