Jay Wademan Peterson, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R48991 Issued in NM

Practice address

201 Cedar St SE
Ste 800
Albuquerque, NM 87106-4917

Phone

(505) 563-2800

Fax

(505) 563-2821

NPI assigned

Jul 27, 2006

Last updated

Oct 23, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224720000000",
    "number": "1821012386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 CEDAR ST SE",
            "address_2": "STE 800",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064917",
            "telephone_number": "505-563-2800",
            "fax_number": "505-563-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 CEDAR ST SE",
            "address_2": "STE 800",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064917",
            "telephone_number": "505-563-2800",
            "fax_number": "505-563-2821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JAY",
        "middle_name": "WADEMAN",
        "name_prefix": "Mr.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2008-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "R48991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47737352",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia Peterson, PH.D.
• Dana Peterson, MD
• Dustin James Peterson, DMD
• Elizabeth Peterson
• Gretchen Gilbertson Peterson, D.C.
• Jeffrey Peterson
• John David Peterson, DPM
• Jordan Peterson
• Justin Peterson, LPCC
• Kaitlin M Peterson, M.D.

• Family Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; 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.