Chandra Leigh Petro, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71004173A Issued in IN

Practice address

7333 W Jefferson Blvd
Fort Wayne, IN 46804-6280

Phone

(260) 458-3830

NPI assigned

Nov 15, 2012

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: chandra.petro.1@14940.direct.athenahealth.com

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.

• Everside Health Fort Wayne-W Ludwig Rd

  • Primary Care Clinic/Center
  • Fort Wayne, IN
  • NPI 1861880890
  NPD (past)

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1841534880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-479-3516",
            "fax_number": "260-479-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7333 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046280",
            "telephone_number": "260-458-3830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2012 S Park Ave",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "IN",
            "postal_code": "460018194",
            "country_code": "US",
            "telephone_number": "765-724-6226",
            "fax_number": "765-724-6228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRO",
        "first_name": "CHANDRA",
        "middle_name": "LEIGH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71004173A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201120880",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Gail Peterson, RN
• Shalesta Bright Peterson, BA
• Susan K. Peterson, PA
• Monnett Petilos, LPT
• Lisa Lynne Petrass, M.A. ED. C.C.C.-SLP
• Julie Pettibone
• Robert Pettibone, BCBA
• William C Petty, M.D.
• Elizabeth A Pfeiffer, M.D.
• Megyn Pfeiffer

• Family Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; 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.