Provider Demographics
NPI:1437884137
Name:PETTIGREW, JANESSIA CHENELLE (RN)
Entity Type:Individual
Prefix:MISS
First Name:JANESSIA
Middle Name:CHENELLE
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7777 GLEN AMERICA DR APT 370
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-1853
Mailing Address - Country:US
Mailing Address - Phone:314-600-5567
Mailing Address - Fax:
Practice Address - Street 1:7777 GLEN AMERICA DR APT 370
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-1853
Practice Address - Country:US
Practice Address - Phone:314-600-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95260149163WP0809X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult