Jaclyn Jeanai Pettigrew

Key facts

NPI

1346914744

Entity type

Individual (NPI type 1)

Primary specialty

Licensed Practical Nurse 164W00000X

License

95995 (TN)

Practice address

1008 Mount Zion Rd
Union City, TN 38261-7694

Phone

(731) 885-8722

NPI assigned

Aug 9, 2021

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 9, 2021.

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1346914744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 MOUNT ZION RD",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382617694",
            "telephone_number": "731-885-8722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 MOUNT ZION RD",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382617694",
            "telephone_number": "731-885-8722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1008 MT Zion RD",
            "address_purpose": "LOCATION",
            "city": "Union City",
            "state": "TN",
            "postal_code": "38261",
            "country_code": "US",
            "telephone_number": "731-885-8722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTIGREW",
        "first_name": "JACLYN",
        "middle_name": "JEANAI",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-09",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TN",
            "license": "95995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Union City, TN · Licensed Practical Nurse in Tennessee