MEDICARE: KARA DEANNE PETTY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP132483	TX

General Provider Information

NPI Number	:	1083943450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA DEANNE PETTY FNP-C

Provider Business Mailing Address
First Line	:	400 N SAINT PAUL ST STE 1140
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-3145
Country	:	US
Telephone Number	:	972-449-0540
Fax Number	:	972-449-0550

Provider Business Practice Location Address
First Line	:	400 N SAINT PAUL ST STE 1140
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-3145
Country	:	US
Telephone Number	:	972-449-0540
Fax Number	:	972-449-0550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	07/21/2022

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Directions to “ KARA DEANNE PETTY FNP-C” Practice Location

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