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

Timothy Warren Peterson, PA-C

Individual provider Physician Assistant · NPI 1720388218

Timothy Warren Peterson, PA-C is a Physician Assistant in Union, Kentucky. Qualified in 2010, 16 years ago. Practices with Summit Medical Group Inc, a 799-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Indiana and Kentucky.

Years since qualifying
16
Licensed in
IN, KY
In the registry since
2010
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

605 Man O War Blvd
Union, KY 41091-2007
Phone: (859) 578-5669
Fax: (859) 384-0091
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1640 Flossie Dr, Greendale, IN 47025-8424 — (812) 496-3285
  • 405 Violet Rd, Crittenden, KY 41030-8956 — (859) 903-0268

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA1799 (KY)
Physician Assistant Taxonomy 363A00000X · Licence 10001496A (IN)

Record details

NPI number1720388218
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 30, 2010
Last updated in NPPESAugust 3, 2026
Certification dateAugust 3, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Summit Medical Group Inc — 799 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Union