MEDICARE: PEGGY PETTERSON JONES

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	133V00000X	Registered Dietitian	DD0764	MD
2	133V00000X	Registered Dietitian	KY1679	KY

General Provider Information

NPI Number	:	1528117298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY PETTERSON JONES

Provider Business Mailing Address
First Line	:	19902 REGENCY RUN
Second Line	:
City	:	GARDEN RIDGE
State	:	TX
Zip	:	78266-2330
Country	:	US
Telephone Number	:	210-221-6017
Fax Number	:	210-221-7850

Provider Business Practice Location Address
First Line	:	2050 WORTH RD
Second Line	:	ATTN MCHO CL Q
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7533
Country	:	US
Telephone Number	:	210-221-6195
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	09/11/2025

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