Active NPI
Jessica Rose
- Behavior Technician
- Grass Valley, CA
National Provider Identifier
1184398596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 760 S Auburn St
Grass Valley, CA 95945-4318 - Phone
- (530) 265-2281
- NPI assigned
- Aug 9, 2021
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
760 S Auburn St
Grass Valley, CA 95945-4318
Mailing address
10631 Park Avenue Ext
Nevada City, CA 95959-8890
Phone (530) 687-2273
Other names 1
- Jessica Rose Pengelley
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628467200000",
"number": "1184398596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10631 PARK AVENUE EXT",
"city": "NEVADA CITY",
"state": "CA",
"postal_code": "959598890",
"telephone_number": "530-687-2273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 S AUBURN ST",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959454318",
"telephone_number": "530-265-2281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-09",
"last_updated": "2021-08-09",
"certification_date": "2021-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "PENGELLEY",
"middle_name": "ROSE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Grass Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.