Jellirica Peters
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Rollingwood, TX
NPI 1962904722 · NPPES record last updated Mar 1, 2023
Key facts
- NPI
- 1962904722
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- AP136929 (TX)
- Practice address
- 3001 Bee Caves Rd Ste 220
Rollingwood, TX 78746-5590 - Phone
- (512) 777-2591
- NPI assigned
- Mar 7, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Options for Southern Oregon
Practice addresses (Care Compare)
1545 Harbeck Rd
Grants Pass, OR 97527-5605
Phone (541) 476-2373
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190620000538 | TX | Practitioner - Nurse Practitioner | 2860756277 | Reassigns benefits to 3 organizations |
| I20231006002182 | OR | Practitioner - Nurse Practitioner | 2860756277 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP136929 | TX | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Options for Southern Oregon | Current |
Accepting new patients | |
| Kotel Atx | Current |
Accepting new patients | |
| Coos County Oregon | Current |
Accepting new patients | |
| Nueces County Mental Health & Mental Retardation Community Ctr. | Current |
Accepting new patients | |
| United Psychiatry Institute, LLC | Current |
Accepting new patients | |
| Nueces County Mental Health & Mental Retardation Community Ctr | Psychiatric/Mental Health | Current |
Accepting new patients |
| Texas Behavioral Health PLLC | Current |
Accepting new patients | |
| Options for Southern Oregon | Current |
Accepting new patients | |
| Kairos Medical LLC | Past | Accepting new patients |
Locations
281 Laclair St
Coos Bay, OR 97420
Phone (541) 266-6700
1215 SW G St
Grants Pass, OR 97526
Phone (541) 244-4109
1545 Harbeck Rd
Grants Pass, OR 97527
Phone (541) 479-2371
200 Beatty St
Medford, OR 97501
Phone (541) 414-0739
1630 S Brownlee Blvd
Corpus Christi, TX 78404
Phone (361) 980-9652
3733 S Port Ave
Corpus Christi, TX 78415
Phone (361) 886-4628
1546 S Brownlee Blvd
Corpus Christi, TX 78404
Phone (361) 886-6970
106 Whispering Pines Ave
Ste 103
Friendswood, TX 77546
Phone (281) 868-5440
12234 Shadow Creek Pkwy
Ste 104
Pearland, TX 77584
Phone (281) 315-9508
3531 Town Center Blvd S
Ste 102
Sugar Land, TX 77479
Phone (281) 819-1438
3001 Bee Caves Rd
Ste 220
West Lake Hills, TX 78746
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/DEBFAD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | AP136929 | TX | Yes |
Addresses
Primary practice location
3001 Bee Caves Rd Ste 220
Rollingwood, TX 78746-5590
Mailing address
3001 Bee Caves Rd Ste 220
Rollingwood, TX 78746-5590
Phone (512) 229-9691
Other practice location 1
12234 Shadow Creek Pkwy
Pearland, TX 77584-7330
Phone (713) 289-5325
Other practice location 2
2121 Biscayne Blvd # 1013
Miami, FL 33137-5013
Phone (855) 306-7786
Other names
- Jellirica Tan
Other providers in Rollingwood, TX
- Emmanuel John Lee
- Lejla Medic
- Wayne Nguyen
- Marisa Ievans O'Connor
- Kruti Patel
- Jonathan William Prokop
- Richard Family Chiropractic, PA
- Al Dean Richard
- Jacob Rodriguez
- Yulia Shtareva
All providers in Rollingwood, TX · Psychiatric/Mental Health Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.