Jacqueline Rae Pettit
Behavior Technician in Piedmont, MO. Individual provider (NPI-1).
NPI number1629935564
StatusActive
Last updated in NPPESJan 5, 2026
Details
- NPI
- 1629935564
- Entity type
- Individual (NPI-1)
- Name
- Jacqueline Rae Pettit
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 5, 2026
- Certification date
- Jan 5, 2026
- Last updated
- Jan 5, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
5 Sugar Creek RdPiedmont, MO 63957-9612
Phone 573-223-7649
Mailing address
5 Sugar Creek RdPiedmont, MO 63957-9612
Phone 573-223-7649
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 37 Behavior Technician providers in Piedmont · All 176 providers in Piedmont
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