Active NPI
Jessica Peterson, LSW
- Social Worker
- Shelbyville, KY
National Provider Identifier
1083043632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 3739
- Practice address
- 5228 Cypress CT
Shelbyville, KY 40065-7764 - Phone
- (502) 640-9094
- Fax
- (502) 647-2469
- NPI assigned
- Nov 4, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 3739 | KY | Primary |
Addresses
Primary practice location
5228 Cypress CT
Shelbyville, KY 40065-7764
Mailing address
5228 Cypress CT
Shelbyville, KY 40065-7764
Phone (502) 640-9094
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3739 | KY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383523200000",
"number": "1083043632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5228 CYPRESS CT",
"city": "SHELBYVILLE",
"state": "KY",
"postal_code": "400657764",
"telephone_number": "502-640-9094",
"fax_number": "502-647-2469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5228 CYPRESS CT",
"city": "SHELBYVILLE",
"state": "KY",
"postal_code": "400657764",
"telephone_number": "502-640-9094",
"fax_number": "502-647-2469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JESSICA",
"name_prefix": "Mrs.",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-11-04",
"last_updated": "2013-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "KY",
"license": "3739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelbyville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.