Latisha Renee Petty

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

0024195858 Issued in VA

Practice address

1429 Halifax St
Petersburg, VA 23803-5933

Phone

(540) 748-6048

NPI assigned

Jan 16, 2026

Sex

Female

Sole proprietor

Yes

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

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1768521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768521600000",
    "number": "1245199280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1429 HALIFAX ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238035933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1429 HALIFAX ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238035933",
            "telephone_number": "540-748-6048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "LATISHA",
        "middle_name": "RENEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-01-16",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "VA",
            "license": "0024195858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Petersburg Pharmacy PLLC
• Petersburg Public Schools
• Damon Peterson, M.ED, PBSF
• Tammy Faye Peterson
• Heather M Pettis, M.D.
• Justin Andrew Phillingane, D.P.M.
• Sarah Neal Phillips
• Phoenix N Peace LLC
• Phoenix-N-Peace Acr, Inc.
• Phoenixmides LLC

• Primary Care Nurse Practitioner in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Primary Care Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.