# JESSICA LAINE PEATROSS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1689704074
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 42752 | KY | — |
| 208D00000X | General Practice Physician | 139872 | CA | Yes |

## Other

- **Enumeration date:** 03/06/2007
- **Last updated:** 02/23/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000624958 | NIS/ANTHEM | — |
| 01 | — | 000026447Q | NIS/HUMANA | — |
| 01 | — | 107156 | SIHO/NIS | — |
| 01 | — | 50025070 | PHP/NIS | — |