Healthcare Provider Details

I. General information

NPI: 1376479931
Provider Name (Legal Business Name): MRS. NATALIE GINA PETTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 N MEDICAL CENTER DR E STE 305
CLOVIS CA
93611-6892
US

IV. Provider business mailing address

5558 N THOMPSON AVE
CLOVIS CA
93619-8702
US

V. Phone/Fax

Practice location:
  • Phone: 559-387-2140
  • Fax:
Mailing address:
  • Phone: 559-270-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: