Provider Demographics
NPI:1063068682
Name:PETERS, ARIANNE JADE (BS)
Entity type:Individual
Prefix:MRS
First Name:ARIANNE
Middle Name:JADE
Last Name:PETERS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3487
Mailing Address - Country:US
Mailing Address - Phone:859-254-1035
Mailing Address - Fax:
Practice Address - Street 1:324 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3487
Practice Address - Country:US
Practice Address - Phone:859-254-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-11
Last Update Date:2025-06-11
Deactivation Date:2020-12-15
Deactivation Code:
Reactivation Date:2023-08-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYO13-406-264Medicaid