Provider Demographics
NPI:1801950399
Name:PETTY, SAMANTHA R (APN, RN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:PETTY
Suffix:
Gender:F
Credentials:APN, RN
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 21867
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0867
Mailing Address - Country:US
Mailing Address - Phone:423-899-0500
Mailing Address - Fax:423-899-2411
Practice Address - Street 1:11808 KINGSTON PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3838
Practice Address - Country:US
Practice Address - Phone:423-899-0500
Practice Address - Fax:423-899-2411
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000039380163W00000X
TNAPN0000005270363L00000X
TN163WR1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered163WR1000XNursing Service ProvidersRegistered NurseReproductive Endocrinology/Infertility