Jason Paul Pettus

Primary specialty

DriverTaxonomy code 172A00000X

License

942803758 Issued in AR

Practice address

16 Whispering Oak Dr
Mabelvale, AR 72103-2065

Phone

(501) 400-5306

NPI assigned

Apr 6, 2023

Last updated

Apr 6, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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": "1680739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1558056481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 WHISPERING OAK DR",
            "city": "MABELVALE",
            "state": "AR",
            "postal_code": "721032065",
            "telephone_number": "501-400-5306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 WHISPERING OAK DR",
            "city": "MABELVALE",
            "state": "AR",
            "postal_code": "721032065",
            "telephone_number": "501-400-5306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTUS",
        "first_name": "JASON",
        "middle_name": "PAUL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-06",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": "AR",
            "license": null,
            "primary": false
        },
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "AR",
            "license": "942803758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Driver in Mabelvale, AR
• Providers in Mabelvale, AR by specialty
• Driver in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; 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.