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NPI Code Detail

MEDICARE: ANDREA IRENE PETTY PMHNP

MEDICARE: ANDREA IRENE PETTY PMHNP
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
1101Y00000XCounselor811308NV
2363LP0808XPsychiatric/Mental Health Nurse Practitioner95015570CA
3363LP0808XPsychiatric/Mental Health Nurse Practitioner811308NV

General Provider Information

NPI Number : 1194387886
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA IRENE PETTY PMHNP
Provider Business Mailing Address
First Line : 3210 W CHARLESTON BLVD STE 2
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0080
Country : US
Telephone Number : 725-286-1855
Fax Number : 725-286-1877
Provider Business Practice Location Address
First Line : 3210 W CHARLESTON BLVD STE 2
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0080
Country : US
Telephone Number : 702-444-0768
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2019
Last Update Date : 11/02/2023

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Directions to “ ANDREA IRENE PETTY PMHNP” Practice Location

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