JACQUELINE PETTAWAY (NPI# 1841695954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841695954 |
| Entity Type | Individual |
| Full Name | JACQUELINE PETTAWAY |
| Credential | CRNP |
| Practice Address |
11398 Braga Dr Daphne AL 36526-6568 |
| Mailing Address |
1398 Braga Dr Daphne AL 36526-6568 |
| Practice Telephone | 2515996206 |
| Mailing Telephone | 2515996206 |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2014-10-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
1-076204 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
11398 BRAGA DR |
| City | DAPHNE |
| State | AL |
| Zip Code | 36526-6568 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578173464 | H3o Living, LLC | Clinic/Center | 29000 U.S. 98, Daphne, AL 36526 | 2020-08-05 |
| 1790345403 | Gregory Conner Reese | Student in an Organized Health Care Education/Training Program | 27654 Red Eagle Drive, Daphne, AL 36526 | 2019-06-14 |
| 1649787912 | Jubilee Family Dentistry, LLC | Dentist | 6475 Jordan Avenue, Daphne, AL 36526 | 2018-01-08 |
| 1770090607 | Gary Andrew Gould | Physician Assistant | 28490 2nd St Ste B, Daphne, AL 36526 | 2017-12-31 |
| 1366957011 | Emily Jane Tisdale | Behavioral Analyst | 1203 Us Highway 98 Ste 2a9, Daphne, AL 36526 | 2017-12-04 |
| 1437680600 | Blair Hoffman Pringle | Nurse Practitioner | 26179 Capitol Drive Suite A, Daphne, AL 36526 | 2017-03-21 |
| 1275915324 | Simara Sokom | Pharmacist | 29487 State Highway 181, Daphne, AL 36526 | 2015-06-25 |
| 1366859126 | Seth Matthew Gross | Pharmacist | 101b Villa Drive, Suite B-260, Daphne, AL 36526 | 2014-07-14 |
| 1841627940 | Michelle Renae Counts | Counselor | 9086 Merritt Road Suite C, Williamsburg Plaza, Daphne, AL 36526 | 2013-10-03 |
| 1194066613 | Ryan Nobles | Chiropractor | 6483 Van Buren Street, Suite 101, Daphne, AL 36526 | 2013-03-07 |
| Find all providers in zip 36526 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750547204 | Brandy Lynn Rhodes | Nurse Practitioner | 8832 Us Hwy 90, Daphne, AL 36526 | 2008-08-04 |
| 1861699670 | Linda Sue Grimme Fontenot | Nurse Practitioner | 431 Village Dr, Daphne, AL 36526-4003 | 2007-06-27 |
| 1477170272 | Kaleigh Hornberger | Nurse Practitioner | 1505 Daphne Ave, Daphne, AL 36526-4298 | 2020-06-29 |
| 1851931521 | Ashleigh Boyington | Nurse Practitioner | 28490 2nd St, Daphne, AL 36526-7150 | 2020-01-10 |
| 1497301139 | Bethany King | Nurse Practitioner | 29653 Anchor Cross Blvd, Daphne, AL 36526-9594 | 2019-08-16 |
| 1427610351 | Batisia Lexzondria Lewis | Nurse Practitioner | 28490 2nd St Ste B, Daphne, AL 36526 | 2019-07-01 |
| 1649833666 | Tabbata Castillo Rivers | Nurse Practitioner | 7400 Roper Ln, Daphne, AL 36526-5274 | 2019-04-16 |
| 1740728609 | Candice Marie Nelson | Nurse Practitioner | 28119 N Main St, Daphne, AL 36526-7037 | 2017-02-10 |
| 1487102810 | Holly Scott | Nurse Practitioner | 1505 Daphne Ave, Daphne, AL 36526-4298 | 2016-09-14 |
| 1972953081 | Seneca Walden | Nurse Practitioner | 1505 Daphne Ave, Daphne, AL 36526-4298 | 2016-06-20 |
| Find all providers in DAPHNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.