Peterson Functional Medicine

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PETERSON FUNCTIONAL MEDICINE

Doing business as

Peterson Functional Medicine

Practice address

1860 Old State Rd
Venus, PA 16364-2316

Phone

(814) 673-3830

NPI assigned

Jan 13, 2025

Last updated

Jan 13, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Lynn Peterson, DNP, CRNPNPI 1902688526

Title

Owner

Phone

(814) 673-3830

Specialties & licenses 1

Addresses

Other names 1

• Peterson Functional Medicine Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Lynn Peterson, DNP, FNP, CNL

  • Family Nurse Practitioner
  • Venus, PA
  • NPI 1902688526
  NPD Authorized official

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

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1689484420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 OLD STATE RD",
            "city": "VENUS",
            "state": "PA",
            "postal_code": "163642316",
            "telephone_number": "814-673-3830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 OLD STATE RD",
            "city": "VENUS",
            "state": "PA",
            "postal_code": "163642316",
            "telephone_number": "814-673-3830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON FUNCTIONAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-673-3830",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DNP, CRNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson Functional Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Lynn Peterson, DNP, FNP, CNL

• Family Medicine Physician in Venus, PA
• Providers in Venus, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 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.