Jimmie Peterson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

4913 W Reno Ave
Oklahoma City, OK 73127-6339

Phone

(405) 948-4900

Fax

(405) 948-4933

NPI assigned

May 11, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1417483405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4913 W RENO AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731276339",
            "telephone_number": "405-948-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4913 W RENO AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731276339",
            "telephone_number": "405-948-4900",
            "fax_number": "405-948-4933"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12821 Stratford Dr Apt 236",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731208438",
            "country_code": "US",
            "telephone_number": "405-361-9807",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JIMMIE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-11",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Peterson
• Barbara Myra Peterson, APRN-CNP
• Chelsea Peterson, MD
• James Christian Peterson, MD
• Jermaine Peterson, M.ED.
• Jo Elle Grace Peterson, MD
• Kathy Grant Peterson, P.T.
• Kim Peterson, LADC
• Kourtney Peterson
• Lauren Collier Peterson, PT, DPT

• Peer Specialist in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Peer Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; 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.