Provider Demographics
NPI:1780787853
Name:PETTY, CHERYL Y (RN,MSN,NP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:Y
Last Name:PETTY
Suffix:
Gender:F
Credentials:RN,MSN,NP
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:Y
Other - Last Name:PETTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN,MSN,NP
Mailing Address - Street 1:8118 CONARROE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1210
Mailing Address - Country:US
Mailing Address - Phone:317-337-0488
Mailing Address - Fax:317-988-2884
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:RM. C-1058
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2744
Practice Address - Fax:317-988-2884
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28087874A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner