Provider Demographics
NPI:1497415277
Name:PETTIS, CATHY NICOLE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:NICOLE
Last Name:PETTIS
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-3126
Mailing Address - Country:US
Mailing Address - Phone:501-920-3883
Mailing Address - Fax:501-916-9449
Practice Address - Street 1:1813 EXECUTIVE SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6086
Practice Address - Country:US
Practice Address - Phone:870-899-0884
Practice Address - Fax:870-587-1514
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR218452363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health