Quintina B Petty, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

245972 Issued in NC

Practice address

951 Wendover Height Dr
Shelby, NC 28150-3565

Phone

(704) 487-4677

NPI assigned

Dec 17, 2018

Last updated

Dec 17, 2018By the provider in NPPES

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 NC, SC2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifesource of North CarolinaGroup PAC ID 7416132428, 172 clinicians

Lifesource Prime IncGroup PAC ID 7810336385, 52 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifesource of North Carolina

  • Internal Medicine Physician
  • Wilmington, NC
  • NPI 1811286156

  Psychiatry

  Medicare reassignment Care Compare group NPD
• Lifesource Prime Inc

  • Family Medicine Physician
  • Wilmington, NC
  • NPI 1598533275
  Medicare reassignment Care Compare group NPD
• Complete Care Psychiatry PLLC

  • Nurse Practitioner
  • Raleigh, NC
  • NPI 1295561587

  SC

  Medicare reassignment Authorized official
• Lifesource of North Carolina

  • Psychologist
  • Milton, FL
  • NPI 1730648288

  Psychiatry

  NPD
• Lifesource Prime Inc

  • Family Medicine Physician
  • Richmond, VA
  • NPI 1548124159
  NPD

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545004800000",
    "number": "1851862734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 WENDOVER HEIGHT DR",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 WENDOVER HEIGHT DR",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503565",
            "telephone_number": "704-487-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "QUINTINA",
        "middle_name": "B",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-17",
        "last_updated": "2018-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "245972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danaye Mokma Perez, PA-C
• Performance Auto
• Robert Sandborn Perkins, MD
• Personal Development Services, LLC (Motorsports Personal Development)
• Dennis Wayne Pettis
• Abigail Mairead Phelps, MD
• Tracy Lee Phelps, MD
• Evelyn Philbeck, R.PH.
• Mindy Self Philbeck, LCSWA
• Sarah Nantz Philbeck, LCMHC

• Family Nurse Practitioner in Shelby, NC
• Providers in Shelby, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; 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.