Provider Demographics
NPI:1629107339
Name:PETTIGREW, JAN MCCRARY (PHD RN)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MCCRARY
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:PHD RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N UNIVERSITY AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207
Mailing Address - Country:US
Mailing Address - Phone:501-663-7211
Mailing Address - Fax:501-664-5660
Practice Address - Street 1:1501 N UNIVERSITY AVE
Practice Address - Street 2:STE 203
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207
Practice Address - Country:US
Practice Address - Phone:501-663-7211
Practice Address - Fax:501-664-5660
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR18000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse