MEDICARE: MS. JACQUELINE A PETERS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN0000006824	TN
2	363LP0200X	Pediatric Nurse Practitioner	APN0000006824	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144267279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE A PETERS NP

Provider Business Mailing Address
First Line	:	301 WOLVERINE TRL
Second Line	:	SUITE 100
City	:	SMYRNA
State	:	TN
Zip	:	37167-5656
Country	:	US
Telephone Number	:	615-459-6700
Fax Number	:	615-459-0068

Provider Business Practice Location Address
First Line	:	301 WOLVERINE TRL
Second Line	:	SUITE 100
City	:	SMYRNA
State	:	TN
Zip	:	37167-5656
Country	:	US
Telephone Number	:	615-459-6700
Fax Number	:	615-459-0068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	02/05/2008

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