Cynthia Louise Petty, APN

Primary specialty

Child & Adolescent Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0807X

License

209000709 Issued in IL

Practice address

Uic, Ijr, 1747 West Roosevelt Road, M/C 747
Cu 113
Chicago, IL 60608

Phone

(312) 413-1136

Fax

(312) 413-4459

NPI assigned

Jan 14, 2009

Sex

Female

Sole proprietor

No

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": "1231891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231891200000",
    "number": "1841437787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UIC, IJR, 1747 WEST ROOSEVELT ROAD, M/C 747",
            "address_2": "CU 113",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60608",
            "telephone_number": "312-413-1136",
            "fax_number": "312-413-4459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UIC, IJR, 1747 WEST ROOSEVELT ROAD, M/C 747",
            "address_2": "CU 113",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60608",
            "telephone_number": "312-413-1136",
            "fax_number": "312-413-4459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "CYNTHIA",
        "middle_name": "LOUISE",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-14",
        "last_updated": "2009-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "IL",
            "license": "209000709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilbur P Pettitt Jr., DDS
• Ethan Pettiway, MPT
• Alexander Jonathan Petts
• Markia Lenise Pettway, DO
• Taylor Ariel Pettway, MS
• Danielle Petty, PT, DPT
• Jan Petty, MD
• Kellie N Petty
• Mary Lou Petty, MSW LCSW
• Janese London Petuchowski, OT

• Child & Adolescent Psychiatric/Mental Health Registered Nurse in Chicago, IL
• Providers in Chicago, IL by specialty
• Child & Adolescent Psychiatric/Mental Health Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.