Provider Demographics
NPI:1104659325
Name:PETERSON, JAYME (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JAYME
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12020 N HOLLY WAY
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8086
Mailing Address - Country:US
Mailing Address - Phone:970-619-0518
Mailing Address - Fax:
Practice Address - Street 1:11310 HURON ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3090
Practice Address - Country:US
Practice Address - Phone:303-925-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1000049-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily