Provider Demographics
NPI:1487200853
Name:PETTIT, ANDREW SPENCER (DNP, NP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SPENCER
Last Name:PETTIT
Suffix:
Gender:M
Credentials:DNP, NP, FNP-BC
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 198560
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:348 E 4500 S STE 300
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8535
Practice Address - Country:US
Practice Address - Phone:801-266-2777
Practice Address - Fax:801-266-1377
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8671455-4405363LF0000X, 363LF0000X
CARN95206908163W00000X
WAAP60974091363LF0000X
CANP95013529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse