Petersen Clinic, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

941 Issued in WV

Legal business name

PETERSEN CLINIC, PLLC

Practice address

119 Main St W
Suite a
Oak Hill, WV 25901-2943

Phone

(304) 465-0544

Fax

(304) 465-8832

NPI assigned

Jul 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bruce N. Petersen, DO

Title

Co-Owner

Phone

(304) 465-0544

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1235169384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 MAIN ST W",
            "address_2": "SUITE A",
            "city": "OAK HILL",
            "state": "WV",
            "postal_code": "259012943",
            "telephone_number": "304-465-0544",
            "fax_number": "304-465-8832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 MAIN ST W",
            "address_2": "SUITE A",
            "city": "OAK HILL",
            "state": "WV",
            "postal_code": "259012943",
            "telephone_number": "304-465-0544",
            "fax_number": "304-465-8832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "304-465-0544",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "942",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "1864",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0084786001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeannette Pennington
• Jerry L. Pennington, DDS
• Sara Pennington
• Amy Perdue
• Kimberly D Perkins
• Bruce Norman Petersen, DO
• Millie Williams Petersen, DO
• Ernestine NMN Phillips, R,D,LD
• Holly Phillips
• Misty Phillips

• Internal Medicine Physician in Oak Hill, WV
• Providers in Oak Hill, WV by specialty
• Internal Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.