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NPI Code Detail

MEDICARE: KATHY PETRIE ANP

MEDICARE:   KATHY  PETRIE  ANP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner4704271968MI
2363LA2200XAdult Health Nurse PractitionerRN314101GA

General Provider Information

NPI Number : 1598197667
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY PETRIE ANP
Provider Business Mailing Address
First Line : PO BOX 740013
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0013
Country : US
Telephone Number : 312-733-9730
Fax Number :
Provider Business Practice Location Address
First Line : 1825 ROCKBRIDGE RD STE 15B
Second Line :
City : STONE MOUNTAIN
State : GA
Zip : 30087-3306
Country : US
Telephone Number : 470-444-3134
Fax Number : 470-276-4370
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2013
Last Update Date : 02/02/2023

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Directions to “ KATHY PETRIE ANP” Practice Location

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