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Individual

MS. JENIFER R. PETERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
1202 E BUTLER RD, GREENVILLE, SC 29607-5910
(864) 627-3800
(864) 672-2654
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
930
SC
363A00000X
Physician Assistant
Primary
PA930
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0287PA
SC
01
AA06356910
MEDICARE PTAN
SC
Enumeration date
06/28/2006
Last updated
02/11/2025
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