Patricia Ann Petretic, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

AR 92-26P Issued in AR

Practice address

7 E Colt Square Dr
Fayetteville, AR 72703-2884

Phone

(479) 575-0868

NPI assigned

May 7, 2009

Last updated

May 7, 2009By 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

Other names 1

• Dr. Patricia Ann Petretic-Jackson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1241654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241654400000",
    "number": "1558595348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2144 CLEAR CREEK DR",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727647326",
            "telephone_number": "479-751-7604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 E COLT SQUARE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032884",
            "telephone_number": "479-575-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRETIC",
        "first_name": "PATRICIA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-07",
        "last_updated": "2009-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AR",
            "license": "AR 92-26P",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PATRICIA",
            "last_name": "PETRETIC-JACKSON",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily Peterson, O.D
• Micah Peterson
• Rachel Ann Peterson, M.S., L.A.C
• Skye C Peterson, BS, QBHP
• Anton Cyril Petrash, MD
• Claire Petrie, MS, CCC-SLP
• David P Petros, M.D.
• Keeli Holden Pfeiffer, LCSW
• Hanh Kieu Pham, RPH
• Madeline Phan

• Clinical Psychologist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Clinical Psychologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; 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.