Individual
JUDY JONES PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
600 MORRIS ST, SUITE 103, CHARLESTON, WV 25301-1409
(304) 388-7040
(304) 388-7041
Mailing address
415 MORRIS ST, SUITE 304, CHARLESTON, WV 25301-1842
(304) 388-7782
(304) 388-7788
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1108
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0041503000
—
WV
01
—
P0106337
MEDICARE RAILROAD
WV
Enumeration date
04/08/2009
Last updated
09/06/2012
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