Provider Demographics
NPI:1144267279
Name:PETERS, JACQUELINE A (NP)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:A
Last Name:PETERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:A
Other - Last Name:GIONET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:301 WOLVERINE TRL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5656
Mailing Address - Country:US
Mailing Address - Phone:615-459-6700
Mailing Address - Fax:615-459-0068
Practice Address - Street 1:301 WOLVERINE TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5656
Practice Address - Country:US
Practice Address - Phone:615-459-6700
Practice Address - Fax:615-459-0068
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006824363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908400Medicaid
TN3908400Medicaid
TN39084001Medicare PIN