OrganizationPeterson Wellness Primary Care And Pediatrics, PllcClinic/CenterAmbulatory Health Care FacilitiesPractice Address109 W Commercial St, Broken Arrow, OK 74012-4012(918) 724-3952PECOS EnrollmentBased on the most recent information from CMS, provider Peterson Wellness Primary Care And Pediatrics, Pllc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1851062517Provider TypeOrganizationFull NamePeterson Wellness Primary Care And Pediatrics, PllcSubpartNoEnumeration Date9/22/2021Last Updated9/22/2021Contact InformationPractice LocationPractice Address109 W Commercial St, Broken Arrow, OK 74012-4012Phone(918) 724-3952FaxUnlisted FaxMailing LocationMailing Address9701 Spring Lake Dr, Broken Arrow, OK 74014-3426Phone(918) 724-3952FaxUnlisted FaxAuthorized OfficialNamePeterson, Ashton Danielle (Nurse Practitioner, Owner)Phone(918) 724-3952Provider TaxonomiesCodeDescriptionLicenseCode261QP2300XPrimaryDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID200833910ADescriptionMedicaidIssuerUnlistedOklahoma