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General NPI Number Information
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NPI Number | 1447713102
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Entity Type | Individual
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Provider Name | JESSICA LEE PETERSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 12230 LIONESS WAY
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City | PARKER
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State | CO
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Zip | 80134-5603
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Country | US
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Telephone | 720-644-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 12230 LIONESS WAY
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City | PARKER
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State | CO
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Zip | 80134-5603
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Country | US
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Telephone | 720-644-9355
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.1626086
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RXN.0103823-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0994416-NP
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License Number State | CO
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