Andrew Nathan Pettibon, LMP

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA00056514 Issued in WA

Practice address

4141 6TH Ave
Suite 2
Tacoma, WA 98406-4032

Phone

(253) 228-0889

NPI assigned

Apr 23, 2007

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457579385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 65248",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984641248",
            "telephone_number": "253-565-3369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4141 6TH AVE",
            "address_2": "SUITE 2",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984064032",
            "telephone_number": "253-228-0889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIBON",
        "first_name": "ANDREW",
        "middle_name": "NATHAN",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA00056514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Petri
• Jodi J Petrinovich, P.T.
• Lyudmila Ivanovna Petruk, MD
• Peter Allan Petrukitas, ARNP
• Kristina Siu Petsas, M.D.
• Jon M Pettibon, D.C.
• Rex Pettibon, LMP
• Tamesha R Pettie
• Jennifer Pettigrew, LMP
• Melissa C Pettini, ARNP

• Specialist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.