Jeremy Petty

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-22-250369 Issued in AL

Practice address

100 Spenryn Dr
Madison, AL 35758-1890

Phone

(256) 910-8466

NPI assigned

Jan 3, 2023

Last updated

Jan 3, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

State licenses

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

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1336852698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 JERI ST NW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358101932",
            "telephone_number": "256-910-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SPENRYN DR",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357581890",
            "telephone_number": "256-910-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "JEREMY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "AL",
            "license": "RBT22-250369",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "AL",
            "license": "RBT-22-250369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Samuel Peterson, D.P.T
• Debra E Peterson, P.T.
• Jake William Ryan Petraszewsky
• Paige Pettaway, PHARM. D
• Anthony Dwain Pettus Jr.
• Miley Nhi Phan, RPH
• Pharmacy Express, Inc.
• Pharmacy of Madison, LLC
• Hailey Phelps
• Janet Phillips, CRNP

• Behavior Technician in Madison, AL
• Providers in Madison, AL by specialty
• Behavior Technician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; 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.