Regina D Petty, MSN, APRN, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11018524 Issued in FL

Practice address

15462 Spotted Stallion TRL
Jacksonville, FL 32234-2398

Phone

(352) 328-0571

NPI assigned

Apr 17, 2020

Sex

Female

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

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: regina.petty.1@9357.direct.athenahealth.com

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.

• Assessments Inc

  • Mental Health Counselor
  • Jensen Beach, FL
  • NPI 1063160752
  NPD

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1669092888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15462 SPOTTED STALLION TRL",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322342398",
            "telephone_number": "352-328-0571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15462 SPOTTED STALLION TRL",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322342398",
            "telephone_number": "352-328-0571"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4300 SW 13th St",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326084006",
            "country_code": "US",
            "telephone_number": "352-374-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTY",
        "first_name": "REGINA",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "MSN, APRN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-17",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9339167",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11018524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quinton Pettaway
• Paul Pettit, MD
• Rachel Deborah Amaru Pettway
• Beverly Jean Petty, PA-C
• Jennifer Sharell Petty, PHARMD
• Rolanda Denise Petty
• Kaitlyn Pettyjohn, LCSW
• Alyssa Murphy Peyton, PA-C
• Stephanie Peyton, LCSW-QS
• Christopher Mario Pezzi, MD

• Psychiatric/Mental Health Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.