Provider Demographics
NPI:1427510437
Name:PETERSON, JENNIFER J (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 W THOMAS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3383
Mailing Address - Country:US
Mailing Address - Phone:623-349-1771
Mailing Address - Fax:623-399-1958
Practice Address - Street 1:9250 W THOMAS RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3383
Practice Address - Country:US
Practice Address - Phone:623-349-1771
Practice Address - Fax:623-399-1958
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ224279363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care