JACOB EDWARD PETERSON (NPI# 1295196384) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295196384 |
| Entity Type | Individual |
| Full Name | JACOB EDWARD PETERSON |
| Practice Address |
620 John Paul Jones Cir Portsmouth VA 23708-2111 |
| Mailing Address |
4441 Birch Rd Portsmouth VA 23703-1501 |
| Practice Telephone | 7579533647 |
| Mailing Telephone | 8606388878 |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2019-07-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208D00000X | General Practice | 0101263068 | VA | Allopathic & Osteopathic Physicians |
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | 0101263068 | VA | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871515593 | Jacob Aaron Peterson | Chiropractor | 434 N Star Rd, Holmen, WI 54636-4402 | 2006-07-24 |
| 1154939262 | Jacob John Peterson | Pharmacist | 1825 Logan Ave, Waterloo, IA 50703-1916 | 2020-07-15 |
| 1720555055 | Jacob Peterson | Registered Nurse | 811 Madison St, Everett, WA 98203-4543 | 2018-10-24 |
| 1679954028 | Jacob Christopher Peterson | Family Medicine | 983075 Nebraska Medical Ctr, Unmc Dept. of Family Medicine, Omaha, NE 68198-3075 | 2015-06-11 |
| 1912391475 | Jacob Michael Peterson | Counselor | 7204 Skyway, Paradise, CA 95969-3280 | 2015-03-23 |
| 1841600137 | Jacob Louis Peterson | Case Manager/Care Coordinator | 5667 S Redwood Rd, Taylorsville, UT 84123-5433 | 2014-05-07 |
| 1235249442 | Jacob R Peterson | Anesthesiologist Assistant | 1836 South Ave, La Crosse, WI 54601-5429 | 2006-08-30 |
| Street Address |
620 JOHN PAUL JONES CIR |
| City | PORTSMOUTH |
| State | VA |
| Zip Code | 23708-2111 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427054840 | Debra Tooke Crowell | Registered Nurse | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2005-06-21 |
| 1659970424 | Jennifer T Birchwale | Student in an Organized Health Care Education/Training Program | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-10-22 |
| 1861091985 | Carin Kimberly Teeters | Psychologist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-10-20 |
| 1275130825 | Dartangion Pierre Walker | Dental Hygienist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-10-07 |
| 1750996054 | Kevin Wilfong | Psychologist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-09-14 |
| 1598379901 | Paula Shepard | Psychologist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-09-02 |
| 1578177234 | Rebekah Gunter | Psychologist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-09-01 |
| 1225641863 | Dylan Quoc-chuong Vu | Dentist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-08-24 |
| 1467060111 | Ili Yuan | Dentist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-07-20 |
| 1750909172 | Marsades Ceasar | Social Worker | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932724754 | William Dowling | Student in an Organized Health Care Education/Training Program | 260 John Paul Jones Circle, Fpo, AA 23708 | 2020-06-09 |
| 1760003156 | Kylie Miller | Student in an Organized Health Care Education/Training Program | 600 John Paul Jones Circle, Portsmouth, VA 23708 | 2020-04-27 |
| 1750900304 | Jonathan David Hickman | Student in an Organized Health Care Education/Training Program | Nmcp 620 John Paul Jones Cir., Bldg 3, Portsmouth, VA 23708 | 2020-04-14 |
| 1447716550 | Nathan Le Holterman | Student in an Organized Health Care Education/Training Program | Navy Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708 | 2019-02-13 |
| 1467930545 | Jonathan Volland | Dentist | Naval Medical Center - 620 John Paul Jones Cr, Portsmouth, VA 23708 | 2018-08-01 |
| 1629570171 | Brendan James O'shea | Student in an Organized Health Care Education/Training Program | 690 John Paul Jones Circle, Fpo, AA 23708 | 2018-03-01 |
| 1467909077 | Patricia Hicks Smith | Nurse Practitioner | 620 John Paul Jones Blvd., Naval Medical Center Portsmouth, Portsmouth, VA 23708 | 2016-09-01 |
| 1790139392 | Lauren Pitters | Student in an Organized Health Care Education/Training Program | 620 John Paul Jones Circle Drive, Naval Medical Center Portsmouth, Portsmouth, VA 23708 | 2016-04-20 |
| 1841683745 | Karrie Anne Brondell Walker | Student in an Organized Health Care Education/Training Program | 620 John Paul Jones, Naval Medical Center Portsmouth, Portsmouth, VA 23708 | 2015-03-17 |
| 1962821967 | Jody Manners | Psychiatry & Neurology | 620 John Paul Jones Cir # 2e, Portsmouth, VA 23708 | 2014-04-08 |
| Find all providers in zip 23708 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407470305 | Nisha Vanmali | Student in an Organized Health Care Education/Training Program | 25 Newhampshire Ave, Suite 100, Portsmouth, NH 03801 | 2020-06-05 |
| 1760003156 | Kylie Miller | Student in an Organized Health Care Education/Training Program | 600 John Paul Jones Circle, Portsmouth, VA 23708 | 2020-04-27 |
| 1750900304 | Jonathan David Hickman | Student in an Organized Health Care Education/Training Program | Nmcp 620 John Paul Jones Cir., Bldg 3, Portsmouth, VA 23708 | 2020-04-14 |
| 1528687456 | Raji Shaher | Student in an Organized Health Care Education/Training Program | Portsmouth Regional Hospital, 333 Borthwick Avenue Portsmouth, Nh 03801, Portsmouth, NH 03801 | 2020-04-10 |
| 1376176461 | Joshua L Cartwright | Student in an Organized Health Care Education/Training Program | 303 Deal Dr, Portsmouth, VA 23701-1307 | 2020-02-17 |
| 1528627965 | Amy M Baker | Student in an Organized Health Care Education/Training Program | 3640 High Street, Suite 2f Portsmouth Family Medicine, Portsmouth, VA 23707 | 2019-06-10 |
| 1235796459 | Cloria Robertson | Student in an Organized Health Care Education/Training Program | 3604 Tejo Ln Apt 2b, Portsmouth, VA 23703-3032 | 2019-05-22 |
| 1033774625 | Himani Bhasin | Student in an Organized Health Care Education/Training Program | 3640 High Street (suite 2f), Evms Family Medicine - Portsmouth Program, Portsmouth, VA 23707 | 2019-05-08 |
| 1851854442 | Emma Daymond | Student in an Organized Health Care Education/Training Program | 3640 High Street, Suite 2f, Portsmouth, VA 23707 | 2019-04-10 |
| 1760943195 | Jessica Albers | Student in an Organized Health Care Education/Training Program | 3 Paddle Ct, Portsmouth, VA 23703-5361 | 2019-03-28 |
| Find all providers in PORTSMOUTH | ||||
| City | PORTSMOUTH |
| Zip Code | 23708 |
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| 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.