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General NPI Number Information
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NPI Number | 1558595348
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Entity Type | Individual
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Provider Name | PATRICIA ANN PETRETIC PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 05/07/2009
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Provider Practice Location Address
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Address Line | 7 E COLT SQUARE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2884
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Country | US
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Telephone | 479-575-0868
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Fax |
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Provider Business Mailing Address
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Address Line | 2144 CLEAR CREEK DR
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City | SPRINGDALE
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State | AR
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Zip | 72764-7326
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Country | US
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Telephone | 479-751-7604
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | AR 92-26P
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License Number State | AR
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