Jennifer Nicole Petty

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

621 SW Alder St Ste 520
Portland, OR 97205-3620

Phone

(503) 418-5311

Fax

(503) 494-4747

NPI assigned

Apr 29, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1651190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1396480893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 SW ALDER ST STE 520",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053620",
            "telephone_number": "503-418-5311",
            "fax_number": "503-494-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 SW ALDER ST STE 520",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053620",
            "telephone_number": "503-418-5311",
            "fax_number": "503-494-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "JENNIFER",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-29",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101YM0800X",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kersti Pettit-Kekel, OT
• Brandon James Pettit, BA
• Jody L Pettit, MD
• Kelly Janet Pettit
• Nicholas A Pettit, DO
• Michelle Elizabeth Petty
• Randi Michelle Petty, RDH
• Terry Lee Petty, DC
• Pettygrove Dental LLC
• Pettygrove Physical Therpay Associates LLC

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; 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.