Petra Wattigney

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-51975 Issued in TN

Practice address

1727 N Germantown Pkwy Ste 107
Cordova, TN 38016-3328

Phone

(901) 509-8347

Fax

(855) 430-0596

NPI assigned

Jul 31, 2021

Last updated

Jul 31, 2021By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1627689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627689600000",
    "number": "1346913613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3075 WOODLAND CREST DR",
            "city": "LAKELAND",
            "state": "TN",
            "postal_code": "380023908",
            "telephone_number": "225-305-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 N GERMANTOWN PKWY STE 107",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380163328",
            "telephone_number": "901-509-8347",
            "fax_number": "855-430-0596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTIGNEY",
        "first_name": "PETRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-31",
        "last_updated": "2021-07-31",
        "certification_date": "2021-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TN",
            "license": "1-21-51975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "855-430-0596",
            "affiliation": "N",
            "endpointDescription": "Fax",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Fax",
            "address_1": "1727 N Germantown Pkwy Ste 107",
            "city": "Cordova",
            "state": "TN",
            "country_code": "US",
            "postal_code": "380163328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Behavior Analyst in Cordova, TN
• Providers in Cordova, TN by specialty
• Behavior Analyst in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2021; 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.