Jamie Keith Pettus, LPN

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

6701 Highway 67 BLDG 70
Benton, AR 72015-8909

Phone

(501) 315-3344

Fax

(501) 303-3186

NPI assigned

Aug 29, 2007

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": "1188345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255305600000",
    "number": "1417141920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 HIGHWAY 67 BLDG 70",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720158909",
            "telephone_number": "501-315-3344",
            "fax_number": "501-303-3186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 HIGHWAY 67 BLDG 70",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720158909",
            "telephone_number": "501-315-3344",
            "fax_number": "501-303-3186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTUS",
        "first_name": "JAMIE",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-29",
        "last_updated": "2009-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AR",
            "license": "L38028",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Lindsey Pervis
• Cassidyn Petersen
• Lari Peterson, RECOVERY ASSISTANT
• Dawn Pettit, PLMSW
• Annicia Patrice Pettus, MS, RD, LD
• Melissa Pettus
• Ann Pevahouse, DDS
• Pharmacy Care of Benton, LLC
• Richard E Phelan, D.D.S.
• Skyler Phelps, M.S., CCC-SLP

• Case Manager/Care Coordinator in Benton, AR
• Providers in Benton, AR by specialty
• Case Manager/Care Coordinator in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2009; 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.