Provider Demographics
NPI:1912341470
Name:PETRAS, MISTY C (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:C
Last Name:PETRAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ASTOR ST
Mailing Address - Street 2:
Mailing Address - City:WELLFORD
Mailing Address - State:SC
Mailing Address - Zip Code:29385-9622
Mailing Address - Country:US
Mailing Address - Phone:864-439-5338
Mailing Address - Fax:
Practice Address - Street 1:102 ASTOR ST
Practice Address - Street 2:
Practice Address - City:WELLFORD
Practice Address - State:SC
Practice Address - Zip Code:29385
Practice Address - Country:US
Practice Address - Phone:864-439-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106862163W00000X, 163WC0200X, 163WS0200X
SC21997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WS0200XNursing Service ProvidersRegistered NurseSchool