Jacqueline Pettaway, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-076204 Issued in AL

Practice address

1601 Center St
Mobile, AL 36604-1541

Phone

(251) 410-5437

Fax

(251) 434-3876

NPI assigned

Oct 31, 2014

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

Medicare fee-for-service enrollment

Enrolled in AL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• University of South Alabama

  • Family Medicine Physician
  • Mobile, AL
  • NPI 1992746838
  Medicare reassignment NPD
• USA Health Physician Billing Services LLC

  • Internal Medicine Physician
  • Mobile, AL
  • NPI 1720645468
  Medicare reassignment NPD
• University of South Alabama

  • Clinical Medical Laboratory
  • Mobile, AL
  • NPI 1497859052
  NPD
• University of South Alabama

  • Internal Medicine Physician
  • Mobile, AL
  • NPI 1700241015
  NPD
• USA Health Physician Billing Services LLC

  • Diagnostic Radiology Physician
  • Mobile, AL
  • NPI 1609434067
  NPD
• USA Health Physician Billing Services LLC

  • Radiation Oncology Physician
  • Mobile, AL
  • NPI 1871150508
  NPD
• University of South Alabama Mitchell Cancer Institute

  • Multi-Specialty Clinic/Center
  • Mobile, AL
  • NPI 1023210259
  NPD (past)

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

{
    "created_epoch": "1414713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1841695954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40480",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366400480",
            "telephone_number": "251-434-3626",
            "fax_number": "251-445-2464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 CENTER ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366041541",
            "telephone_number": "251-410-5437",
            "fax_number": "251-434-3876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTAWAY",
        "first_name": "JACQUELINE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-31",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-076204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Winfred Darrell Petrey, D.C.
• Kendall Avery Petrilla
• Robert Petrossian, M.D.
• Breia Tasia Pettaway
• Demetria Pettaway
• Amy Pettway, CCC-SLP
• Brittany Alaina Pettway
• Ruby Lee Pettway
• Melody Lynn Petty
• Robert C Pfeffle, DMD

• Family Nurse Practitioner in Mobile, AL
• Providers in Mobile, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.