KENDRA PETERSEN
NPI 1417840166
Student in an Organized Health Care Education/Training Program in Minneapolis, MN

Q: What is Kendra Petersen's NPI number?

The NPI number for Kendra Petersen is 1417840166. It was assigned to this individual provider in the NPPES registry on June 2, 2025.

Q: What is Kendra Petersen's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Kendra Petersen was last updated on June 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.

Active since June 02, 2025

2211 RIVERSIDE AVENUE SOUTH, CAMPUS BOX 149, MINNEAPOLIS, MN 55454(612) 330-1399(612) 330-1757 Get Directions Write a Review

NPPES record last updated: June 2, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Kendra Petersen NPPES

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

KENDRA PETERSEN (NPI 1417840166) is an individual student in an organized health care education/training program in Minneapolis, Minnesota and active in the NPI registry since June 2025.

NPPES Registry Identity

NPI1417840166

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameKENDRA PETERSEN

Location Address2211 RIVERSIDE AVENUE SOUTH, CAMPUS BOX 149Minneapolis, MN 55454

Mailing Address2211 Riverside Avenue South, Campus Box 149Minneapolis, MN 55454 · (612) 330-1399 · Fax (612) 330-1757

Phone(612) 330-1399

Fax(612) 330-1757

Sole ProprietorNo

Enumeration DateJune 2, 2025

NPPES CertifiedJune 1, 2025

✔ NPI 1417840166 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedPhysician AssistantTaxonomy 363A00000X

2211 RIVERSIDE AVENUE SOUTH, Minneapolis, MN 55454

Open in Google Maps ↗

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 Kendra Petersen's NPI number?

The NPI number for Kendra Petersen is 1417840166. It was assigned to this individual provider in the NPPES registry on June 2, 2025.

Where is Kendra Petersen located?

Kendra Petersen practices at 2211 Riverside Avenue South Campus Box 149, Minneapolis, MN 55454. The listed phone number is (612) 330-1399.

What is Kendra Petersen's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Kendra Petersen was last updated on June 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.