Active NPI
Jessica Marie Petersen, PA-C
- Physician Assistant
- Salt Lake City, UT
National Provider Identifier
1699167254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 500 Foothill Dr
Dept of Holistic Medicine
Salt Lake City, UT 84148-0001 - Phone
- (801) 582-1565
- NPI assigned
- Feb 19, 2015
- Last updated
- Feb 19, 2015
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NU | Primary |
Addresses
Primary practice location
500 Foothill Dr
Dept of Holistic Medicine
Salt Lake City, UT 84148-0001
Mailing address
500 Foothill Dr
Dept of Holistic Medicine
Salt Lake City, UT 84148-0001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424304000000",
"number": "1699167254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 FOOTHILL DR",
"address_2": "DEPT OF HOLISTIC MEDICINE",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841480001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 FOOTHILL DR",
"address_2": "DEPT OF HOLISTIC MEDICINE",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841480001",
"telephone_number": "801-582-1565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JESSICA",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-19",
"last_updated": "2015-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.