Provider Demographics
NPI:1912874470
Name:PETTY, AARON ARTHUR
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:ARTHUR
Last Name:PETTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 SW COAST HWY STE 204
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-5064
Mailing Address - Country:US
Mailing Address - Phone:541-819-5678
Mailing Address - Fax:
Practice Address - Street 1:644 SW COAST HWY STE 204
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5064
Practice Address - Country:US
Practice Address - Phone:541-819-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program