Jenny Petersen

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Practice address

1628 34TH CT
Kenosha, WI 53144-3368

Phone

(262) 308-5857

NPI assigned

Apr 30, 2025

Sex

Female

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": "1745971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1689462327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1628 34TH CT",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531443368",
            "telephone_number": "262-308-5857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1628 34TH CT",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531443368",
            "telephone_number": "262-308-5857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JENNY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-30",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandi Peters, LAT
• Jennie L Peters, PMHNP-BC, FNP
• Lori Peters, RN
• Bennet Petersen, MS, OTR/L
• Dawn Petersen, CSAC
• Kristen K Petersen, SLP
• Chelsey Ruth Peterson
• Craig A. Peterson, D.M.D
• Karen A Peterson, M.D.
• Kristopher Wyllis Peterson, DC

• Adult Care Home Facility in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Adult Care Home Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.