DR. JACQUELINE BERNADINE PETRAVAGE (NPI# 1104861079) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104861079 |
| Entity Type | Individual |
| Full Name | DR. JACQUELINE BERNADINE PETRAVAGE |
| Credential | M.D. |
| Practice Address |
Veteran's Hospital, 500 Foothill Blvd Bldg 47 Salt Lake City UT 84148-0001 |
| Mailing Address |
500 Foothill Blvd Salt Lake City UT 84148-0001 |
| Practice Telephone | 8015821565 |
| Practice Fax Number | 8015842544 |
| Mailing Telephone | 8015821565 |
| Mailing Fax Number | 8015842544 |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
1664161205 | UT | Allopathic & Osteopathic Physicians |
| Street Address |
VETERAN'S HOSPITAL, 500 FOOTHILL BLVD BLDG 47 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84148-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598211799 | Jacquelyn Rae Contant | Dietitian, Registered | 500 Foothill Dr. (120), Salt Lake City, UT 84148 | 2016-08-28 |
| 1699127811 | Taylor Alford | Pharmacist | 500 Foothills Drive, Salt Lake City, UT 84148 | 2016-07-12 |
| 1356792162 | Sarah Hummel | Genetic Counselor, MS | 500 Foothill Drive, Sarah Hummel, Va Salt Lake City, Genomic Medicine (10p4e), Salt Lake City - Salt Lake, UT 84148 | 2016-06-23 |
| 1174936140 | Elizabeth Shade Cardenas | Nurse Practitioner | 500 Foothill Drive #182h, Veterans Healthcare Administration, Salt Lake City, UT 84148 | 2014-06-08 |
| 1386904043 | David Earl Moore | Specialist | 500 Foothill Blvd (research), George E. Wahlen Va Healthcare System, Salt Lake City, UT 84148 | 2012-05-29 |
| 1790059038 | Deborah Ernstein Holley Hartzfeld | Genetic Counselor, MS | 615 Arapeen Drive #212, Salt Lake City, UT 84148 | 2012-03-05 |
| 1073823720 | Diana Lynn Robbins | Social Worker | 9140 W. Post Road, Las Vegas, NV 84148 | 2010-10-15 |
| 1659534394 | Katherine Margaret Dunn | Genetic Counselor, MS | 500 Foothill Drive (151z), Salt Lake City, UT 84148 | 2008-07-02 |
| 1730381625 | Douglas James Ball | Medical Genetics | Va Salt Lake City Health Care System 10p11, Salt Lake City, UT 84148 | 2007-06-03 |
| 1245339530 | Daniel H Priestly | Radiology | 500 Foothill Dr., Salt Lake City, UT 84148 | 2006-09-22 |
| Find all providers in zip 84148 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811549637 | Nume Tms Utah, Pllc | Psychiatry & Neurology | 560 S 300 E Ste 115, Salt Lake City, UT 84111-3562 | 2019-07-11 |
| 1497288351 | Tyler Durns | Psychiatry & Neurology | 50 N Medical Dr Salt Lake City, Salt Lake City, UT 84132-0001 | 2017-04-07 |
| 1457705279 | Heather Wark | Psychiatry & Neurology | 3313 E Coronet Dr, Salt Lake City, UT 84124-3102 | 2016-04-18 |
| 1114311255 | Shane Verhoef | Psychiatry & Neurology | 500 Foothill Dr Bldg 16, Salt Lake City, UT 84148-1023 | 2015-03-26 |
| 1376947051 | University of Utah Behavioral Health Services | Psychiatry & Neurology | 30 N 1900 E Ste 1b620, Salt Lake City, UT 84132-0002 | 2014-10-09 |
| 1700120334 | R. Duncan Wallace, M.d., P.C. | Psychiatry & Neurology | 2972 S Devonshire Cir, Salt Lake City, UT 84108-2526 | 2012-11-20 |
| 1336407790 | Anthony Michael Petersen | Psychiatry & Neurology | University of Utah Psychiatry Department, 50 North Medical Drive, Salt Lake City, UT 84132-0001 | 2012-04-24 |
| 1982971826 | Robert Allan Weitzel | Psychiatry & Neurology | 78 U St, Salt Lake City, UT 84103-4304 | 2011-11-21 |
| 1427349042 | Kristen Leigh Pagel | Psychiatry & Neurology | 30 N 1900 E Rm 1c412, Gme Office, Salt Lake City, UT 84132-0002 | 2011-04-30 |
| 1952690919 | Brent Michael Kious | Psychiatry & Neurology | University Hospital 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2011-03-30 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84148 |
Please comment or provide details below to improve the information on DR. JACQUELINE BERNADINE PETRAVAGE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.