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NPI Code Detail

MEDICARE: RENEE DELISE PETTIS PA-C

MEDICARE: RENEE DELISE PETTIS PA-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
1363AM0700XMedical Physician Assistant247DC
2363AM0700XMedical Physician AssistantPA.200446LA
3363AM0700XMedical Physician AssistantPA247DC
4363AM0700XMedical Physician AssistantPA07388TX
5363A00000XPhysician AssistantPA07388TX

General Provider Information

NPI Number : 1568504827
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE DELISE PETTIS PA-C
Provider Business Mailing Address
First Line : 8325 BROADWAY ST STE 220
Second Line :
City : PEARLAND
State : TX
Zip : 77581-5773
Country : US
Telephone Number : 281-764-8527
Fax Number :
Provider Business Practice Location Address
First Line : 412 TELEPHONE RD
Second Line :
City : HOUSTON
State : TX
Zip : 77023-1840
Country : US
Telephone Number : 713-926-6229
Fax Number : 713-926-9105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 04/14/2021

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Directions to “ RENEE DELISE PETTIS PA-C” Practice Location

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