Active NPI
Jerrod R Peterson, RN
- Registered Nurse
- Nespelem, WA
National Provider Identifier
1164864856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R32809
- Practice address
- 19 Lakes Street
Nespelem, WA 99155-0071 - Phone
- (509) 634-2900
- Fax
- (509) 634-2945
- NPI assigned
- Jul 23, 2013
- Last updated
- Jul 23, 2013
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R32809 | ND | Primary |
Addresses
Primary practice location
19 Lakes Street
Nespelem, WA 99155-0071
Mailing address
PO Box 71
Nespelem, WA 99155-0071
Phone (509) 634-2900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7139660 | Medicaid | WA | |
| 7139470 | Medicaid | WA |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R32809 | ND | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374537600000",
"number": "1164864856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 71",
"city": "NESPELEM",
"state": "WA",
"postal_code": "991550071",
"telephone_number": "509-634-2900",
"fax_number": "509-634-2945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 LAKES STREET",
"city": "NESPELEM",
"state": "WA",
"postal_code": "991550071",
"telephone_number": "509-634-2900",
"fax_number": "509-634-2945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JERROD",
"middle_name": "R",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-23",
"last_updated": "2013-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "ND",
"license": "R32809",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7139660",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7139470",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nespelem, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.