Active NPI
Betty Jetawo
- Case Manager/Care Coordinator
- Garland, TX
National Provider Identifier
1568690576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 3256 Southern Dr Ste 466
Garland, TX 75043-1533 - Phone
- (972) 240-5070
- NPI assigned
- Jun 29, 2009
- Last updated
- Jul 9, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | NU | ||
| Case Manager/Care Coordinator | 171M00000X | NU | Primary |
Addresses
Primary practice location
3256 Southern Dr Ste 466
Garland, TX 75043-1533
Mailing address
PO Box 494462
Garland, TX 75049-4462
Phone (972) 240-5070
Other practice location 1
2201 Club Creek Cir
Garland, TX 75043-1479
Phone (214) 641-8494
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Betty a Jetawo | Current | Accepting new patients | |
| Golden Hawk Medical | Current | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Golden Hawk Medical Supplies
- Durable Medical Equipment & Medical Supplies
- Garland, TX
- NPI 1053644112
-
- Case Management Agency
- Garland, TX
- NPI 1487977849
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594252800000",
"number": "1568690576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 494462",
"city": "GARLAND",
"state": "TX",
"postal_code": "750494462",
"telephone_number": "972-240-5070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3256 SOUTHERN DR STE 466",
"city": "GARLAND",
"state": "TX",
"postal_code": "750431533",
"telephone_number": "972-240-5070"
}
],
"practiceLocations": [
{
"address_1": "2201 Club Creek Cir",
"address_purpose": "LOCATION",
"city": "Garland",
"state": "TX",
"postal_code": "750431479",
"country_code": "US",
"telephone_number": "214-641-8494",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JETAWO",
"first_name": "BETTY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-29",
"last_updated": "2020-07-09",
"certification_date": "2020-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.