Provider Demographics
NPI:1720589864
Name:PETTY, BRITTANY NICOLE
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICOLE
Last Name:PETTY
Suffix:
Gender:F
Credentials:
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 373
Mailing Address - Street 2:
Mailing Address - City:ECTOR
Mailing Address - State:TX
Mailing Address - Zip Code:75439-0373
Mailing Address - Country:US
Mailing Address - Phone:903-486-5198
Mailing Address - Fax:
Practice Address - Street 1:406 WEST SAM RAYBURN
Practice Address - Street 2:
Practice Address - City:ECTOR
Practice Address - State:TX
Practice Address - Zip Code:75439
Practice Address - Country:US
Practice Address - Phone:903-486-5198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX920097163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse