Active NPI
Leonora K Petty, MD
- Psychiatry Physician
- Beaumont, TX
National Provider Identifier
1194778894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- P6242
- Practice address
- 2750 S 8TH St
Beaumont, TX 77701-7719 - Phone
- (409) 839-1000
- NPI assigned
- May 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 20578 | MS | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | MD035524L | PA | |
| Psychiatry Physician | 2084P0800X | P6242 | TX | Primary |
Addresses
Primary practice location
2750 S 8TH St
Beaumont, TX 77701-7719
Mailing address
2750 S 8TH St
Beaumont, TX 77701-7719
Phone (409) 839-1000
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 302I269052 | Other | MS | MEDICARE |
| 109062 | Medicaid | AL | |
| 04428702 | Medicaid | MS | |
| 1014016060001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P6242 | TX | MD | Psychiatry Physician |
| 20578 | MS | MD | Child & Adolescent Psychiatry Physician |
| MD035524L | PA | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650412800000",
"number": "1194778894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2750 S 8TH ST",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777017719",
"telephone_number": "409-839-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2750 S 8TH ST",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777017719",
"telephone_number": "409-839-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "LEONORA",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-17",
"last_updated": "2022-04-20",
"certification_date": "2022-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "MS",
"license": "20578",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "PA",
"license": "MD035524L",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "P6242",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "302I269052",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "109062",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04428702",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1014016060001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.