Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kendra Petersen

Individual provider Physician Assistant · NPI 1417840166

Kendra Petersen is a Physician Assistant in Minneapolis, Minnesota. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
2

Practice location Address checks out

2211 Riverside Avenue South Campus Box 149
Minneapolis, MN 55454
Phone: (612) 330-1399
Fax: (612) 330-1757
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1417840166
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 2, 2025
Last updated in NPPESJune 2, 2025
Certification dateJune 1, 2025
Mailing address2211 Riverside Avenue South, Campus Box 149, Minneapolis, MN 55454

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