Sharon Kay Tucker Pettway, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M1291 Issued in TX

Practice address

13105 Wortham Center Dr
Houston, TX 77065-5611

Phone

(713) 442-4000

NPI assigned

Apr 24, 2007

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

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: spettway3766@direct.kelsey-seybold.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.

• Kelsey-Seybold Medical Group, PLLC

  • Multi-Specialty Clinic/Center
  • Houston, TX
  • NPI 1013915255

  Pediatrics

  Medicare reassignment NPD
• Village Chiropractic and Wellness P.L.L.C.

  • Chiropractor
  • League City, TX
  • NPI 1972750719
  NPD (past)

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1740409234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11511 SHADOW CREEK PKWY",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775847298",
            "telephone_number": "713-442-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13105 WORTHAM CENTER DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770655611",
            "telephone_number": "713-442-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTWAY",
        "first_name": "SHARON",
        "middle_name": "KAY TUCKER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "M1291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "353816702",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "353816701",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spettway3766@direct.kelsey-seybold.com",
            "affiliation": "N",
            "endpointDescription": "digital contact information",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "13105 Wortham Center Dr",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770655611",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://ssrx.ksnet.com/FhirProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR endpoint URL",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "13105 Wortham Center Dr",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770655611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Renee Delise Pettis, PA-C
• George Walter Pettit, MD
• Makenzie Pettit
• Nathan James Pettit, D.M.D., M.S.D.
• Deborah Pettway
• Ann K. Petty, MT-BC, NMT
• Gary Leon Petty, PHD
• Kristi L Petty, RD
• Mary Pomeroy Petty, LPC
• Paige Petty

• Pediatrics Physician in Houston, TX
• Providers in Houston, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.