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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MRS. JENNIFER LOUISE PETERSEN NURSE PRACTITIONER
NPI 1629053343
Nurse Practitioner - Family in Fort Drum, NY

Active since December 15, 2005
11050 MOUNT BELVEDERE BLVD, USA MEDDAC ATTN: CREDENTIALS, FORT DRUM, NY 13602(315) 772-4025(315) 772-9498 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mrs. Jennifer Louise Petersen Nurse Practitioner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. JENNIFER LOUISE PETERSEN NURSE PRACTITIONER (NPI 1629053343) is an individual family provider in Fort Drum, New York, licensed in Kansas (44888) and active in the NPI registry since December 2005.

NPPES Registry Identity

NPI1629053343
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMRS. JENNIFER LOUISE PETERSENCredential: NURSE PRACTITIONER
Location Address11050 MOUNT BELVEDERE BLVD, USA MEDDAC ATTN: CREDENTIALSFort Drum, NY 13602-5438
Mailing Address11050 Mount Belvedere Blvd, Usa Meddac Attn: CredentialsFort Drum, NY 13602-5438 · (315) 772-4025 · Fax (315) 772-9498
Phone(315) 772-4025
Fax(315) 772-9498
Sole ProprietorNo
Enumeration DateDecember 15, 2005
Last NPPES UpdateJuly 13, 2026
✔ NPI 1629053343 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in KS · 44888
11050 MOUNT BELVEDERE BLVD, Fort Drum, NY 13602
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. LAUREL JARVIS PH.D.
Psychologist (Clinical)
11050 MOUNT BELVEDERE BLVD, BEHAVIORAL HEALTH DEPARTMENT, MEDDAC
FORT DRUM, NY 13602
Jefferson County (315) 772-4850
DAVID LEWIS KEYES RPA-C
Physician Assistant
11050 MOUNT BELVEDERE BLVD, USA MEDDAC CREDENTIALS
FORT DRUM, NY 13602
Jefferson County (315) 772-5508
BRADY SIMPKINS PA-C
Physician Assistant
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (802) 258-0301
MS. MARY ANGELA MACCULLOCH LCSW
Social Worker (Clinical)
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (315) 772-7624
DR. ISAAC P MILLS DO
Family Medicine
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (315) 772-2778
SAVITRI MOTAPARTHI M.D.
Pediatrics
11050 MOUNT BELVEDERE BLVD, USA MEDDAC /CREDENTIALS
FORT DRUM, NY 13602
Jefferson County (315) 772-4025
DR. LUTHER ROSWELL WIEST D.O.
Family Medicine
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (315) 772-3679
MADISON GERMAN LCSW
Social Worker (Clinical)
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (315) 772-2778

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 Jennifer Petersen's NPI number?

The NPI number for Jennifer Petersen is 1629053343. It was assigned to this individual provider in the NPPES registry on December 15, 2005.

Where is Jennifer Petersen located?

Jennifer Petersen practices at 11050 Mount Belvedere Blvd Usa Meddac Attn: Credentials, Fort Drum, NY 13602. The listed phone number is (315) 772-4025.

What is Jennifer Petersen's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Jennifer Petersen was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 25 days 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.