Provider Demographics
NPI:1619738721
Name:PETTIGREW, LORI (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 COUNTY ROAD 4878
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-6253
Mailing Address - Country:US
Mailing Address - Phone:254-247-8232
Mailing Address - Fax:
Practice Address - Street 1:483 COUNTY ROAD 4878
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-6253
Practice Address - Country:US
Practice Address - Phone:254-247-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1107080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily