Provider Demographics
NPI:1689755753
Name:PETIT, SONDRA C (NP)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:C
Last Name:PETIT
Suffix:
Gender:F
Credentials:NP
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 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:817-735-0400
Mailing Address - Fax:817-735-0111
Practice Address - Street 1:855 MONTGOMERY ST
Practice Address - Street 2:DEPT OF OB/GYN
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-927-1065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245715363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143498702Medicaid
TX8N8815OtherBCBS
TX143498702Medicaid
TX8D9112Medicare PIN
TXP20477Medicare UPIN