Petty Adult and Geriatric Care Clinic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

11466 Issued in TN

Legal business name

PETTY ADULT AND GERIATRIC CARE CLINIC LLC

Practice address

1123 N Castle Heights Ave
Suite H
Lebanon, TN 37087-5724

Phone

(615) 443-2273

Fax

(615) 449-3111

NPI assigned

Oct 25, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Ann Petty, APRN

Title

Organizer

Phone

(615) 443-2273

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1457530560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1123 N CASTLE HEIGHTS AVE",
            "address_2": "SUITE H",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370875724",
            "telephone_number": "615-443-2273",
            "fax_number": "615-449-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 N CASTLE HEIGHTS AVE",
            "address_2": "SUITE H",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370875724",
            "telephone_number": "615-443-2273",
            "fax_number": "615-449-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTY ADULT AND GERIATRIC CARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-25",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ORGANIZER",
        "authorized_official_telephone_number": "615-443-2273",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TN",
            "license": "11466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Robin Perez, FNP
• Nicki Renee Perkins, PA-C
• Anna Petersen
• Kristen Peterson
• Rebecca Pettross
• Petty Orthopaedics PC
• Jennifer Ann Petty, NP
• Mescha Petty, OTR/L
• James D Peyton, M.D.
• Todd Brownell Peyton, LPC

• Clinic/Center in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; 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.