NPIMap

Individual provider Active NPI

Danise A Petticrew, RN, FNP-C

  • Family Nurse Practitioner
  • Paris, TX
National Provider Identifier
1952359200
Registry record updated Jan 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
249797 Issued in TX
Practice address
635 Stone Ave
Paris, TX 75460-9342
Phone
(903) 785-3300
Fax
(903) 785-3310
NPI assigned
May 5, 2006
Last updated
Jan 29, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 249797 TX Primary

Addresses

Primary practice location

635 Stone Ave
Paris, TX 75460-9342

Mailing address

1133 Medical Dr
Tyler, TX 75701-2130
Phone (903) 595-5486

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110907001173 TX Practitioner - Nurse Practitioner 2466622121 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcentral FoundationGroup PAC ID 5496663627, 168 clinicians

Practice addresses (Care Compare)

1 Flight Line Rd
Port Alsworth, AK 99653-9801
Phone (907) 729-6799

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.77 of 100Reported as group
Quality
76.11
Promoting interoperability
100
Improvement activities
40
Cost
79.79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
249797TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation CurrentSince Jan 1, 2019 Accepting new patients
Aleutian Pribilof Islands Association Inc CurrentSince Oct 16, 2025 Accepting new patients
Southcentral Foundation Current Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince Jan 1, 2019 Accepting new patients
Southcentral Foundation Current Accepting new patients
Aleutian Pribilof Islands Assoc Inc CurrentSince Oct 16, 2025 Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Past Accepting new patients
Southcentral Foundation Past Accepting new patients

Locations

1131 E Intl Airport Rd
Anchorage, AK 99518
Phone (907) 276-2700

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

4320 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-0000

7033 E Tudor Rd
Anchorage, AK 99507
Phone (907) 729-0000

Interoperability endpoints

  • Direct secure messaging: dpetticrew@direct.scf.cc

Organizations & group practices 12

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422489600000",
    "number": "1952359200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 MEDICAL DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012130",
            "telephone_number": "903-595-5486",
            "fax_number": "903-595-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 STONE AVE",
            "city": "PARIS",
            "state": "TX",
            "postal_code": "754609342",
            "telephone_number": "903-785-3300",
            "fax_number": "903-785-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTICREW",
        "first_name": "DANISE",
        "middle_name": "A",
        "credential": "RN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2015-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "249797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paris, TX

Sources for this page

Verify at the official NPI Registry.