Provider Demographics
NPI:1083943450
Name:PETTY, KARA DEANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:DEANNE
Last Name:PETTY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N SAINT PAUL ST STE 1140
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3145
Mailing Address - Country:US
Mailing Address - Phone:972-449-0540
Mailing Address - Fax:972-449-0550
Practice Address - Street 1:400 N SAINT PAUL ST STE 1140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3145
Practice Address - Country:US
Practice Address - Phone:972-449-0540
Practice Address - Fax:972-449-0550
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132483363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner