Active NPI
Donovan Pettiford
- Private Vehicle
- Indianapolis, IN
National Provider Identifier
1962974097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Private Vehicle
- License
- 5330-20-5370
- Practice address
- 6128 Morning Dove Dr
Indianapolis, IN 46228-1097 - Phone
- (317) 366-3979
- NPI assigned
- Dec 31, 2018
- Last updated
- Dec 31, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Private Vehicle | 347C00000X | 5330-20-5370 | IN | Primary |
Addresses
Primary practice location
6128 Morning Dove Dr
Indianapolis, IN 46228-1097
Mailing address
6128 Morning Dove Dr
Indianapolis, IN 46228-1097
Phone (317) 366-3979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546214400000",
"number": "1962974097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6128 MORNING DOVE DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462281097",
"telephone_number": "317-366-3979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6128 MORNING DOVE DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462281097",
"telephone_number": "317-366-3979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIFORD",
"first_name": "DONOVAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-12-31",
"last_updated": "2018-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": "IN",
"license": "5330-20-5370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.