Jennifer L Petersen, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

50002511 Issued in OH

Practice address

762 S Cleveland Massillon Rd
Fairlawn, OH 44333-3024

Phone

(330) 665-4100

Fax

(330) 665-4190

NPI assigned

Oct 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366848000000",
    "number": "1871689174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "762 S CLEVELAND MASSILLON RD",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443333024",
            "telephone_number": "330-665-4100",
            "fax_number": "330-665-4190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 S CLEVELAND MASSILLON RD",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443333024",
            "telephone_number": "330-665-4100",
            "fax_number": "330-665-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2013-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50002511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dwynica S Pendleton
• Joshua Penman
• Katherine Pennington
• Paul Pennza, M.D.
• Megan P Perkins, M.A.,CCC-SLP
• Karen Angela Petit, PHYSICAL THERAPIST
• Rachel Ann Petrella, PT, DPT
• Morgan Petroff, OTR
• Cleo Phillips
• Melodie Phillips, MD

• Surgical Physician Assistant in Fairlawn, OH
• Providers in Fairlawn, OH by specialty
• Surgical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; 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.