Jennifer Duckett Siddle, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2005-01904 Issued in NC

Practice address

1400 Crescent GRN
Suite 120
Cary, NC 27518-8118

Phone

(919) 972-7700

NPI assigned

Aug 4, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Jennifer Deon Duckett Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 23, 2013 through Nov 23, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Psychiatry and Psychology Associates, P.a.

  • Child & Adolescent Psychiatry Physician
  • Cary, NC
  • NPI 1932513223
  NPD (past)
• Family Psychiatry Practice & Associates, PLLC

  • Child & Adolescent Psychiatry Physician
  • Cary, NC
  • NPI 1588384572
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404259200000",
    "number": "1104834860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 CRESCENT GRN",
            "address_2": "SUITE 120",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275188118",
            "telephone_number": "910-295-6007",
            "fax_number": "910-215-0179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 CRESCENT GRN",
            "address_2": "SUITE 120",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275188118",
            "telephone_number": "919-972-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDLE",
        "first_name": "JENNIFER",
        "middle_name": "DUCKETT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2014-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2005-01904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903844",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DUCKETT",
            "middle_name": "DEON",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jetal Shukla, NP
• Jacob Shumac
• Alyssa Christine Shupe, PT, DPT
• Siah'S Heart Home Care, L.L.C
• Sufia Siddique, M. D.
• Kathryn Siddle, PHARMD
• Marci Elizabeth Siebeking, PT, DPT
• Kayla Siebold
• Sierra Mental Wellness, PLLC
• Gloria M Sierra, NP

• Psychiatry Physician in Cary, NC
• Providers in Cary, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.