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NPI Code Detail

MEDICARE: MS. MONIQUE DIANE PETTEYS FNP-C

MEDICARE: MS. MONIQUE DIANE PETTEYS 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
1363LF0000XFamily Nurse PractitionerGAANP004418GA

General Provider Information

NPI Number : 1902249675
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MONIQUE DIANE PETTEYS FNP-C
Provider Business Mailing Address
First Line : 647 ACADEMY RD
Second Line :
City : LONG CREEK
State : SC
Zip : 29658-2105
Country : US
Telephone Number : 706-982-4434
Fax Number :
Provider Business Practice Location Address
First Line : 189 BO JAMES ST STE 105
Second Line :
City : CLAYTON
State : GA
Zip : 30525-6199
Country : US
Telephone Number : 706-782-0016
Fax Number : 706-782-0180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2013
Last Update Date : 01/21/2026

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