Active NPI
Jerrell Pettigrew
- Behavior Technician
- Columbia, SC
National Provider Identifier
1386150951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 17-32371
- Practice address
- 1048 Wildwood Centre Dr
Columbia, SC 29229-8420 - Phone
- (803) 999-3752
- NPI assigned
- Dec 19, 2017
- Sex
- Male
- 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 | 17-32371 | SC | Primary |
Addresses
Primary practice location
1048 Wildwood Centre Dr
Columbia, SC 29229-8420
Mailing address
181 W Professional Park CT Ste 1
Bowling Green, KY 42104-3250
Phone (270) 777-9283
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17-32371 | SC | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Living in Kentucky, LLC | Past | Accepting new patients | |
| Gateway Counseling Services | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Murray, KY
- NPI 1518281419
-
- Community/Behavioral Health Agency
- Bowling Green, KY
- NPI 1508278458
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513641600000",
"number": "1386150951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "181 W PROFESSIONAL PARK CT STE 1",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421043250",
"telephone_number": "270-777-9283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1048 WILDWOOD CENTRE DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292298420",
"telephone_number": "803-999-3752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIGREW",
"first_name": "JERRELL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-19",
"last_updated": "2017-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "SC",
"license": "17-32371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.