=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376479931
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. NATALIE GINA PETTY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2026
-----------------------------------------------------
Last Update Date | 06/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 782 N MEDICAL CENTER DR E STE 305
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93611-6892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-387-2140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5558 N THOMPSON AVE
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93619-8702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-270-0194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95021044
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------