JACQUELYN PETERSON
NPI 1124019948
Physician Assistant - Medical in Jamestown, NY
About Jacquelyn Peterson NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACQUELYN PETERSON (NPI 1124019948) is an individual medical provider in Jamestown, New York, licensed in New York (007012) and active in the NPI registry since November 2005. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jacquelyn Peterson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 10
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
JAMESTOWN, NY 14701
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jacquelyn Peterson's NPI number?
The NPI number for Jacquelyn Peterson is 1124019948. It was assigned to this individual provider in the NPPES registry on November 1, 2005.
Where is Jacquelyn Peterson located?
Jacquelyn Peterson practices at 320 Prather Ave, Jamestown, NY 14701. The listed phone number is (716) 753-7107.
What is Jacquelyn Peterson's specialty?
The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.
Is Jacquelyn Peterson enrolled in Medicare?
Yes. Jacquelyn Peterson is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Jacquelyn Peterson was last updated on June 15, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jacquelyn Peterson · NPI 1124019948
Medical physician in Jamestown, New York. Individual provider, active in the CMS NPPES registry since November 1, 2005.
## Identity
- **NPI:** 1124019948 (Entity type: Individual)
- **Enumerated:** November 1, 2005
- **Primary specialty:** Physician Assistant - Medical · taxonomy 363AM0700X
- **State license:** 007012 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 320 PRATHER AVE, Jamestown, NY 14701-6820
- **Phone:** (716) 753-7107
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** June 15, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1124019948) · Data from the CMS NPPES public registry.