Provider Demographics
NPI:1700011855
Name:PETTY, ANN K (MT-BC, NMT)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:K
Last Name:PETTY
Suffix:
Gender:F
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 VALLEY FORGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-1932
Mailing Address - Country:US
Mailing Address - Phone:713-419-9351
Mailing Address - Fax:
Practice Address - Street 1:5914 VALLEY FORGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1932
Practice Address - Country:US
Practice Address - Phone:713-419-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0147174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist