Jessica Lea Petty, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

194 Maready Rd
Jacksonville, NC 28546-9332

Phone

(904) 240-9350

NPI assigned

Apr 19, 2012

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

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": "1334793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334793600000",
    "number": "1407113111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PSC BOX 20125",
            "address_2": "CLR-27 GROUP AID STATION",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285420125",
            "telephone_number": "904-240-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 MAREADY RD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285469332",
            "telephone_number": "904-240-9350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "JESSICA",
        "middle_name": "LEA",
        "name_prefix": "Mrs.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-19",
        "last_updated": "2012-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darin Lee Peterson, MA, LAT, ATC
• Lavoncia Regan Peterson, LCSW, LCASA
• Patrick Joseph Petley, DMD
• Trista A Petrella-McMullen, LPN, LMBT
• Margaret A Petry, APRN-CNM
• Lucia Philipp
• Sarah Faye Cowell Phillips
• Morgan E Phoebus
• Physical Therapy Clinic Inc
• Caryn Rose Piacenti

• Independent Duty Corpsman in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Independent Duty Corpsman in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2012; 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.