Isis Jaijadea Pettway

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

P2304012 Issued in AR

Practice address

4224 Shuffield Dr
Little Rock, AR 72205-7211

Phone

(501) 526-8200

Fax

(501) 526-5296

NPI assigned

Jan 9, 2018

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

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

University of Arkansas for Medical SciencesGroup PAC ID 4082528955, 1,159 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• University of Arkansas for Medical Sciences

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1588654016
  Medicare reassignment Care Compare group NPD
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD
• University of Arkansas for Medical Sciences

  • Nurse Practitioner
  • Little Rock, AR
  • NPI 1629130802
  NPD
• Little Rock Counseling, PLC

  • Professional Counselor
  • Little Rock, AR
  • NPI 1003353368
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1467969659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST # 783",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-666-8000",
            "fax_number": "501-526-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4224 SHUFFIELD DR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057211",
            "telephone_number": "501-526-8200",
            "fax_number": "501-526-5296"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6601 W 12th St",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722041513",
            "country_code": "US",
            "telephone_number": "501-666-8686",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4301 W Markham St # 568",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722057101",
            "country_code": "US",
            "telephone_number": "501-526-8200",
            "fax_number": "501-526-5296",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTWAY",
        "first_name": "ISIS",
        "middle_name": "JAIJADEA",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-09",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "P2304012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Petray
• Velimir Petrovic, M.D.
• Vesna Petrovic, L.AC., DACCHM
• Jan McCrary Pettigrew, PHD RN
• Meghan Faith Pettis, PT
• Julie Lepine Petty, PHARMD
• Gissur Petursson, MD
• Lisa Marie Petursson, M.D.
• Elizabeth A Petz, LCSW
• Joe B Pevahouse, M.D.

• Mental Health Counselor in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.