Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tinesha Shanta Pettiway

Individual provider Gerontology Nurse Practitioner · NPI 1881375780

Tinesha Shanta Pettiway is a Nurse Practitioner in Webster, Texas. Qualified in 2023, 3 years ago. Practices with Minivasive Pain Specialists, PLLC, a 28-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
3
Licensed in
TX
In the registry since
2023
Specialties on file
3
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Practice location Address checks out

205 E Medical Center Blvd # 100
Webster, TX 77598-4376
Phone: (346) 800-6001
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence 1129705 (TX)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence 1129705 (TX)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 1129705 (TX)

Record details

NPI number1881375780
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 25, 2023
Last updated in NPPESOctober 16, 2023
Certification dateOctober 16, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Minivasive Pain Specialists,Pllc — 28 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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