Active NPI
Patricia A Fettes, PHD
- Psychologist
- Saint Croix Falls, WI
National Provider Identifier
1124102736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2159
- Practice address
- 235 E State St
Saint Croix Falls, WI 54024-4117 - Phone
- (715) 483-3221
- Fax
- (715) 483-0507
- NPI assigned
- Oct 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2159 | WI | Primary |
Addresses
Primary practice location
235 E State St
Saint Croix Falls, WI 54024-4117
Mailing address
235 E State St
Saint Croix Falls, WI 54024-4117
Phone (715) 483-3221
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25G96FE | Other | MN | BCBS MN PRO FEE |
| HP27843 | Other | MN | HEALTHPARTNERS |
| NA9031022306 | Other | MN | PREFERRED ONE |
| 27G33FE | Other | MN | BCBS MN FACILITY |
| 39126100 | Medicaid | WI | |
| 874516100 | Medicaid | MN | |
| 61-59205 | Other | MN | MEDICA / UBH |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pfettes166314@excellian.diret.allina.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2159 | WI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1124102736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "235 E STATE ST",
"city": "SAINT CROIX FALLS",
"state": "WI",
"postal_code": "540244117",
"telephone_number": "715-483-3221",
"fax_number": "715-483-0507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 E STATE ST",
"city": "SAINT CROIX FALLS",
"state": "WI",
"postal_code": "540244117",
"telephone_number": "715-483-3221",
"fax_number": "715-483-0507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTES",
"first_name": "PATRICIA",
"middle_name": "A",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-24",
"last_updated": "2021-01-14",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "2159",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MN PRO FEE",
"identifier": "25G96FE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP27843",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "NA9031022306",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MN FACILITY",
"identifier": "27G33FE",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39126100",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "874516100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA / UBH",
"identifier": "61-59205",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "pfettes166314@excellian.diret.allina.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/PDF/TXT",
"address_1": "235 E State St",
"city": "Saint Croix Falls",
"state": "WI",
"country_code": "US",
"postal_code": "540244117",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Saint Croix Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.