Kali Suzanne Nan Petties, T-CTL0220451

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

119 Industrial Ave NE
Albuquerque, NM 87107-2283

Phone

(505) 345-2127

Fax

(505) 345-2127

NPI assigned

Feb 12, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• La Buena Vida, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bernalillo, NM
  • NPI 1386676856
  NPD (past)
• Valle del Sol of New Mexico, LLC

  • Community/Behavioral Health Agency
  • Bernalillo, NM
  • NPI 1649610171
  NPD (past)

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1639210404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8624 BLUFF SPRINGS DR NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132278",
            "telephone_number": "505-681-8153",
            "fax_number": "505-345-2127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 INDUSTRIAL AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871072283",
            "telephone_number": "505-345-2127",
            "fax_number": "505-345-2127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIES",
        "first_name": "KALI",
        "middle_name": "SUZANNE NAN",
        "credential": "T-CTL0220451",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NM",
            "license": "T-CTL0220451",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Petro
• Zachary Gene Petro, LSAA
• Rachel Petroff
• Stuart Pett, MD
• Cathy Anne Petti, MD
• Angela Pettiford
• Raine Pettigrew
• Marissa A Pettit, CNP
• Matthew Pettit
• Margaret Ann Pettus, SLP

• Case Manager/Care Coordinator in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Case Manager/Care Coordinator in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.