Provider Demographics
NPI:1376718080
Name:PETTIT, KATHRYN N (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:N
Last Name:PETTIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2895
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-2895
Mailing Address - Country:US
Mailing Address - Phone:256-735-5071
Mailing Address - Fax:256-801-7626
Practice Address - Street 1:1958 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0609
Practice Address - Country:US
Practice Address - Phone:256-737-2090
Practice Address - Fax:256-737-2091
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.31188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1376718080OtherINDIVIDUAL NPI
AL102I081199Medicare PIN