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

Kevin Lyman Peterson, PA-C

Individual provider Medical Physician Assistant · NPI 1689308744

Kevin Lyman Peterson, PA-C is a Physician Assistant in West Jordan, Utah. Qualified in 2021, 5 years ago. Practices with Catholic Health Initiatives Colorado, a 1,266-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
5
Licensed in
UT
In the registry since
2022
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3570 W 9000 S
West Jordan, UT 84088-8869
Phone: (801) 903-5620
Fax: (385) 351-6718
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 5242 S College Dr Ste 200, Murray, UT 84123-2918 — (385) 365-5053

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 12857669-1206 (UT)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 12857669-1206 (UT)

Record details

NPI number1689308744
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 14, 2022
Last updated in NPPESNovember 26, 2024
Certification dateNovember 26, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Catholic Health Initiatives Colorado — 1266 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in West Jordan