Provider Demographics
NPI:1922344043
Name:PETTY, AMELA RIZVIC
Entity Type:Individual
Prefix:
First Name:AMELA
Middle Name:RIZVIC
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 1:12335 HYMEADOW DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1934
Mailing Address - Country:US
Mailing Address - Phone:512-977-8300
Mailing Address - Fax:512-977-8301
Practice Address - Street 1:12335 HYMEADOW DR
Practice Address - Street 2:SUITE 150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1934
Practice Address - Country:US
Practice Address - Phone:512-977-8300
Practice Address - Fax:512-977-8301
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical