Healthcare Provider Details

I. General information

NPI: 1700355237
Provider Name (Legal Business Name): WILLIAM CHRISTOPHER PETTY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 WILSON ST
FORT SILL OK
73503-4472
US

IV. Provider business mailing address

4301 WILSON ST
FORT SILL OK
73503-4472
US

V. Phone/Fax

Practice location:
  • Phone: 580-558-2635
  • Fax: 580-558-2314
Mailing address:
  • Phone: 580-558-2635
  • Fax: 580-558-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5058
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: