| Doctor Name: | JUDY JONES PETERSEN |
| NPI Number: | 1023251840 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | |
| Business Practice Address: | 600 Morris St Suite 103 Charleston, WV - 253011409 |
| Business Phone Number: | 3043887040 |
| Business Fax Number: | 3043887041 |
| Mailing Address: | 415 Morris St, Suite 304 CHARLESTON |
| State: | WV |
| Postal Code: | 253011842 |
| Phone Number: | 3043887782 |
| Fax Number: | 3043887788 |
| NPI Enumeration Date: | 04/08/2009 |
| NPI Last Update Date: | 09/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | 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. |