Active NPI
Jennifer L Petersen, ATC MS
- Athletic Trainer
- Magnolia, OH
National Provider Identifier
1265586812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT001606
- Practice address
- 1256 Bark Rd
Magnolia, OH 44643 - Phone
- (330) 866-9186
- NPI assigned
- Jan 22, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT001606 | OH | Primary |
Addresses
Primary practice location
1256 Bark Rd
Magnolia, OH 44643
Mailing address
1256 Bark Rd
Magnolia, OH 44643
Phone (330) 866-9186
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
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT001606 | OH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265586812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1256 BARK RD",
"city": "MAGNOLIA",
"state": "OH",
"postal_code": "44643",
"telephone_number": "330-866-9186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1256 BARK RD",
"city": "MAGNOLIA",
"state": "OH",
"postal_code": "44643",
"telephone_number": "330-866-9186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JENNIFER",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "ATC MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "AT001606",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Magnolia, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.