Provider Demographics
NPI:1205370061
Name:PETTY, YOLANDA (RDMS, RVT, RDCS)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:
Last Name:PETTY
Suffix:
Gender:F
Credentials:RDMS, RVT, RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 MEADOWCREEK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2451
Mailing Address - Country:US
Mailing Address - Phone:502-314-1050
Mailing Address - Fax:502-459-3234
Practice Address - Street 1:1926 MEADOWCREEK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2451
Practice Address - Country:US
Practice Address - Phone:502-314-1050
Practice Address - Fax:502-459-3234
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22847246XS1301X, 2471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography