Healthcare Provider Details

I. General information

NPI: 1093229577
Provider Name (Legal Business Name): JENNIFER CATHERINE PETERSON DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 VILLAGE SQ UNIT 2
HAZELWOOD MO
63042-1838
US

IV. Provider business mailing address

445 MERAMEC WAY
SAINT CHARLES MO
63303-8447
US

V. Phone/Fax

Practice location:
  • Phone: 314-455-4321
  • Fax:
Mailing address:
  • Phone: 954-234-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025020561
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: