Provider Demographics
NPI:1053681908
Name:PETTIT, CARRIE ALLRED (FNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ALLRED
Last Name:PETTIT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ALLRED
Other - Last Name:PETTIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:5809 CORPORATE DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-1936
Mailing Address - Country:US
Mailing Address - Phone:919-872-6220
Mailing Address - Fax:
Practice Address - Street 1:5809 CORPORATE DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-1936
Practice Address - Country:US
Practice Address - Phone:919-872-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729727363LF0000X
NC5006138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily