Healthcare Provider Details

I. General information

NPI: 1821232216
Provider Name (Legal Business Name): JESSIE MARIE PETTIT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 N ALVERNON WAY STE 200
TUCSON AZ
85712-1500
US

IV. Provider business mailing address

2980 N SWAN RD STE 225
TUCSON AZ
85712-6024
US

V. Phone/Fax

Practice location:
  • Phone: 520-326-0850
  • Fax: 520-326-0849
Mailing address:
  • Phone: 520-276-6255
  • Fax: 520-525-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41805
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: