Jenny Ta Pettersen, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

23448 Issued in CA

Practice address

818 Webster St
Oakland, CA 94607-4220

Phone

(510) 986-6800

NPI assigned

Aug 8, 2013

Sex

Female

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

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Group practices

Northeast Valley Health CorporationGroup PAC ID 3173517323, 77 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: jenny.pettersen.p1@direct.nevhc.nextgenshare.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.

• Northeast Valley Health Corporation

  • Federally Qualified Health Center (FQHC)
  • Van Nuys, CA
  • NPI 1629079009
  Medicare reassignment Care Compare group NPD
• Northeast Valley Health Corporation

  • Federally Qualified Health Center (FQHC)
  • Santa Clarita, CA
  • NPI 1548960834
  NPD
• Northeast Valley Health Corporation

  • Federally Qualified Health Center (FQHC)
  • Santa Clarita, CA
  • NPI 1881104313
  NPD

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

{
    "created_epoch": "1375920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491696000000",
    "number": "1780016097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 WEBSTER ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946074220",
            "telephone_number": "510-986-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 WEBSTER ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946074220",
            "telephone_number": "510-986-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSEN",
        "first_name": "JENNY",
        "middle_name": "TA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-08",
        "last_updated": "2017-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "23448",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "757451",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maggie Mae Petri, RN
• Shane Petrites, MD
• Harry Petropoulos, M.D
• Ann Margaret Petru, M.D.
• Laura Katherine Petry
• Barbara Petterson, MFT
• Heather Pettitt, RCP, RRT
• Bria Loren Pettway
• Tonya Diane Petty
• Amanda Peugnet

• Family Nurse Practitioner in Oakland, CA
• Providers in Oakland, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2017; 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.