Provider Demographics
NPI:1548801392
Name:PETTY, JOYCE M (RN)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:M
Last Name:PETTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 GRANDVIEW DR STE C
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-2821
Mailing Address - Country:US
Mailing Address - Phone:864-434-7322
Mailing Address - Fax:
Practice Address - Street 1:180 HOLCOMBE RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6421
Practice Address - Country:US
Practice Address - Phone:864-434-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse