Provider Demographics
NPI:1932276466
Name:PETTY, JENNIFER ANN (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:PETTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1123 N CASTLE HEIGHTS AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-5724
Mailing Address - Country:US
Mailing Address - Phone:615-443-2273
Mailing Address - Fax:615-449-3111
Practice Address - Street 1:1123 NORTH CASTLEHEIGHTS AVENUE
Practice Address - Street 2:SUITE H
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1510
Practice Address - Country:US
Practice Address - Phone:615-443-2273
Practice Address - Fax:615-449-3111
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011466363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health