Jacqueline Nicole Fettes

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

400 Stoddard Rd
Richmond, MI 48062-2505

Phone

(810) 392-2167

Fax

(810) 392-2057

NPI assigned

Dec 16, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1481846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1306380845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 ELIZABETH ST",
            "city": "CROSWELL",
            "state": "MI",
            "postal_code": "484221112",
            "telephone_number": "810-712-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 STODDARD RD",
            "city": "RICHMOND",
            "state": "MI",
            "postal_code": "480622505",
            "telephone_number": "810-392-2167",
            "fax_number": "810-392-2057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTES",
        "first_name": "JACQUELINE",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-16",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ez Home Health Care Inc
• Margeret Cindy Faleafine
• Stacey Fauser, IBCLC
• Lyndsey Feldman, PTA
• Syeda Shumi Ferguson
• Robert John Fetzer, M.S., L.M.S.W.
• Diana Dale Fielder, LPN
• Tess Marie Finley, DDS
• Crystal Marie Fistler, RN
• Karsyn Fistler, PTA

• All providers in Richmond, MI
• Addiction (Substance Use Disorder) Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.