Healthcare Provider Details

I. General information

NPI: 1902793730
Provider Name (Legal Business Name): ANNA PETRIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16530 US HIGHWAY 64
SOMERVILLE TN
38068-6185
US

IV. Provider business mailing address

2775 HALLE PKWY
COLLIERVILLE TN
38017-8802
US

V. Phone/Fax

Practice location:
  • Phone: 901-813-8138
  • Fax: 901-813-8793
Mailing address:
  • Phone: 812-217-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: