Bonny Benjamin Petty, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA07479 Issued in TX

Practice address

3001 Joe Dimaggio Blvd Ste 900B
Round Rock, TX 78665-3976

Phone

(512) 729-1800

NPI assigned

Dec 22, 2011

Last updated

Jan 29, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elevate Mental Health PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Georgetown, TX
  • NPI 1013730134
  NPD
• Bcep PA

  • Emergency Medical Services (Emergency Medicine) Physician
  • Austin, TX
  • NPI 1629291844
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1194094961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 CROCKETT GARDENS RD # 200",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786284033",
            "telephone_number": "512-585-8468",
            "fax_number": "512-610-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 JOE DIMAGGIO BLVD STE 900B",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786653976",
            "telephone_number": "512-729-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "BONNY",
        "middle_name": "BENJAMIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-22",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA07479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Peterson, DPT
• Genita Petralli, AMNA
• Erika Amethyst Petre, BCBA, LBA
• Edward Wayne Petrik, M.D.
• Madison Petrmichl, BCBA
• Mo Pezeshk, D.D.S.
• Amber Pfertner
• Christie Minhtrang Pham, DO
• Hali Pham
• Hiep Duy Pham

• Physician Assistant in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.