Provider Demographics
NPI:1952835290
Name:PETTY, LORIE J (APRNCNP)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:J
Last Name:PETTY
Suffix:
Gender:F
Credentials:APRNCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 PIPER ST STE U340
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-6904
Mailing Address - Country:US
Mailing Address - Phone:907-562-0321
Mailing Address - Fax:907-562-2683
Practice Address - Street 1:3851 PIPER ST STE U340
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-6904
Practice Address - Country:US
Practice Address - Phone:907-562-0321
Practice Address - Fax:907-562-2683
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK209330363LA2200X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1742763Medicaid