Active NPI
Petta-Gay Anderson, FNP-BC
- Family Nurse Practitioner
- New York, NY
National Provider Identifier
1245062850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F345011-01
- Practice address
- 1 Penn PLZ FL 8
New York, NY 10119-0899 - Phone
- (646) 761-1725
- NPI assigned
- Aug 14, 2024
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F345011-01 | NY | Primary |
Addresses
Primary practice location
1 Penn PLZ FL 8
New York, NY 10119-0899
Mailing address
1 Penn PLZ FL 8
New York, NY 10119-0899
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241112000885 | NY | Order and Referring Only - Nurse Practitioner | 2860926904 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F345011-01 | NY | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723593600000",
"number": "1245062850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 PENN PLZ FL 8",
"city": "NEW YORK",
"state": "NY",
"postal_code": "101190899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 PENN PLZ FL 8",
"city": "NEW YORK",
"state": "NY",
"postal_code": "101190899",
"telephone_number": "646-761-1725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "PETTA-GAY",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-14",
"last_updated": "2024-08-14",
"certification_date": "2024-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "F345011-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
- Meghan Justine Anderson, DO
- Michael Anderson, M.D.
- Mikaela B Anderson, PA-C
- Molly McKenzie Anderson, AGNP
- Pauline Christine Anderson, AGPCNP
- Randi Lee Anderson, JD, LCSW-R
- Richard C.E. Anderson, M.D.
- Rita Anderson, NP
- Rusian Eloise Anderson, FNP FAMILY NURSE PRA
- Sarah Ann Rachel Anderson, M.D., PH.D
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.