ANETHA DEBORAH PETERSON (FNP) – Family Nurse Practitioner, NPI 1093189904

ANETHA DEBORAH PETERSON (FNP) is a healthcare provider. based in Atlanta, Georgia. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP. They hold a License No. RN164175 (GA). The NPI Number for ANETHA DEBORAH PETERSON (FNP) is 1093189904

Main info

Female
Sole Proprietor
12 Years Of Experience
Accepts Medicare Assignment
Name
ANETHA DEBORAH PETERSON (FNP)
NPI
1093189904
Phone
(678) 464-9424
Address
2171 PEACHTREE ROAD NE
Enumeration Date
17 November 2015
Last Update Date
17 November 2015

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9074516682
Graduation Year
2014 (12 years ago)
PAC ID
0244531309
Group Practice PAC ID
9537050109
Professional Enrollment ID
I20260112000314
Address ID
AK997015926FA1717XSTXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness75
Years active:10State licenses:1Digital endpointsOther names

9,652 NURSE PRACTITIONER in GA

Provider Addresses for ANETHA DEBORAH PETERSON (FNP)

  • 2171 PEACHTREE ROAD NE

    APT 306

    ATLANTA, GA 30309

    Phone: (678) 464-9424

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2026-01-12

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20151214001742INurse PractitionerGATBD
I20260112000314INurse PractitionerTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 30309)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9537050109View full group profile
NameSpecialtyState
-AZ
Nurse PractitionerAK
-TX
Physician AssistantTX
-AK
-ME
Family Practice, Addiction Medicine, Osteopathic Manipulative MedicineAK
Physician AssistantAK
-NY
-AK

Reviews

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Frequently asked questions

What unique ID ties claims to ANETHA DEBORAH PETERSON (FNP)?
NPI 1093189904 is assigned to ANETHA DEBORAH PETERSON (FNP) under the national enumeration system.
Is ANETHA DEBORAH PETERSON (FNP) active in the national directory?
ANETHA DEBORAH PETERSON (FNP)'s public NPI profile is in an active state.
What does ANETHA DEBORAH PETERSON (FNP) treat or focus on?
Patients typically see ANETHA DEBORAH PETERSON (FNP) under the specialty Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where does public data place ANETHA DEBORAH PETERSON (FNP)?
The snapshot lists Atlanta, Georgia for ANETHA DEBORAH PETERSON (FNP); download NPPES for the complete set.
Is ANETHA DEBORAH PETERSON (FNP) a real provider?
This page reflects official NPPES data for NPI 1093189904. Always confirm identity and privileges with the practice and licensing boards.

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