MS. JENNIFER RUTH PETTIBONE RN NPI 1003004474
Registered Nurse (Psychiatric/Mental Health) in Fairfield, CA
About JENNIFER PETTIBONE
Jennifer Pettibone is a provider established in Fairfield, California and her medical specialization is registered nurse (psychiatric/mental health) . The NPI number of Jennifer Pettibone is 1003004474 and was assigned on October 2007. The practitioner's primary taxonomy code is 163WP0808X with license number 464317 (CA). The provider is registered as an individual and her NPI record was last updated 13 years ago.
Jennifer Pettibone is a non-participating provider of Medicare. If you are a Medicare beneficiary this means the provider can charge up to 15% more than Medicare's approved amount for the cost of rendered services, in addition to your normal deductible and coinsurance costs. There are some states that restrict the limiting charge when you see non-participating provider. If you pay the full cost of your care up front, your non- participating provider should still submit a claim to Medicare. Afterward, you should receive reimbursement from Medicare for up 80% of the Medicare-approved amount for the services rendered.
| NPI | 1003004474 |
| Provider Name | MS. JENNIFER RUTH PETTIBONE RN |
| Provider Location Address | 2101 COURAGE DR MS-10-200 FAIRFIELD, CA 94533 |
| Provider Mailing Address | 1048 2ND ST APT 6 NOVATO, CA 94945 |
| Gender | Female |
| NPI Entity Type | Individual |
| Is Sole Proprietor? | No |
| Is Organization Subpart? | N/A |
| Enumeration Date | 10-10-2007 |
| Last Update Date | 10-10-2007 |
Primary Taxonomy
| Taxonomy Code | 163WP0808X |
| Classification | Registered Nurse |
| Type | Nursing Service Providers |
| Specialization | Psychiatric/Mental Health |
| License No. | 464317 |
| License State | CA |
Business Address
MS. JENNIFER RUTH PETTIBONE RN
2101 COURAGE DR
MS-10-200
FAIRFIELD, CA
ZIP 94533
Phone: (707) 784-2154
Mailing Address
MS. JENNIFER RUTH PETTIBONE RN
1048 2ND ST APT 6
NOVATO, CA
ZIP 94945
Phone: (415) 897-1899
Other Providers at the same location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1023178308 | MS. CYNTHIA LYNN BOTT LCSW Individual | Social Worker (Clinical) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2140 |
| 1023182979 | DR. ROBERT PETER DICKEY MD Individual | Pediatrics | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-8662 |
| 1083774814 | MS. MICHELLE GERSON MFT Individual | Marriage & Family Therapist | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2070 |
| 1235244294 | HOMAYOUN FAGHIHI-SHIRAZI M.D. Individual | Psychiatry & Neurology (Psychiatry) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 435-2077 |
| 1306906474 | LEO HELMUTH SADDAM RN Individual | Registered Nurse (Psychiatric/Mental Health) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2101 |
| 1316025216 | XING-XING LUO MD Individual | Psychiatry & Neurology (Psychiatry) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2080 |
| 1336208784 | KELLIE MARIE KEKKI LCSW Individual | Social Worker (Clinical) | 2101 COURAGE DR MS 10-100 FAIRFIELD, CA 94533 (707) 784-2010 |
| 1346300480 | PRISCILLA MARIA DE LEON Individual | Counselor (Mental Health) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2140 |
| 1396736732 | MS. SARAH JANE BOLGER RNP Individual | Nurse Practitioner (Family) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2048 |
| 1427139864 | DR. LAURIE MATIASEVICH DDS Individual | Dentist (Dental Public Health) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2120 |
| 1447336508 | TELECARE CORPORATION Organization | Psychiatric Hospital | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2130 |
| 1487715710 | JULIE L. COOPER R.N. Individual | Registered Nurse (Psychiatric/Mental Health) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2140 |
| 1487715785 | MR. MARC ANTHONY CAMPOS ASW Individual | Social Worker (Clinical) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2140 |
| 1518027309 | KATHY DEMAGGIO RD Individual | Dietitian, Registered | 2101 COURAGE DR NUTRITION, MS 10-100 FAIRFIELD, CA 94533 (707) 784-2216 |
| 1700946035 | NICOLE LUCCHESI Individual | Marriage & Family Therapist | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2140 |
| 1770643074 | MR. ALFREDO ENRIQUE GOMEZ PSYCHOTHERAPIST Individual | Marriage & Family Therapist | 2101 COURAGE DR 10-100 FAIRFIELD, CA 94533 (707) 784-2285 |
| 1811087232 | MISS ANNA MARIE ANTONIO FNP Individual | Nurse Practitioner (Family) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2010 |
| 1821103730 | DR. RAYMOND M. REYES M.D. Individual | Psychiatry & Neurology (Psychiatry) | 2101 COURAGE DR BOX 4090, MAIL STATION 10-300 FAIRFIELD, CA 94533 (707) 435-2080 |
| 1851327316 | MRS. SARAH KATHERINE LAYE M.S., R.D. Individual | Dietitian, Registered | 2101 COURAGE DR MS 10-100, SCH AND SS FAIRFIELD, CA 94533 (707) 435-2213 |
| 1992865224 | CARRIE BERNICE BLOOM Individual | Counselor (Mental Health) | 2101 COURAGE DR FAIRFIELD, CA 94533 (707) 784-2140 |
NPI Footnotes
What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date
The date that a NPI record was last updated or changed.
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.