Healthcare Provider Details

I. General information

NPI: 1386825321
Provider Name (Legal Business Name): PAIGE S PETTIT R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HIGHWAY 51 S LAUDERDALE COUNTY HEALTH DEPARTMENT
RIPLEY TN
38063-4583
US

IV. Provider business mailing address

500 HIGHWAY 51 S LAUDERDALE COUNTY HEALTH DEPARTMENT
RIPLEY TN
38063-4583
US

V. Phone/Fax

Practice location:
  • Phone: 731-635-4661
  • Fax:
Mailing address:
  • Phone: 731-635-4661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number158257
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: