Tyray M Petty

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

6305 W Overland Rd
Boise, ID 83709-3029

Phone

(208) 605-3663

NPI assigned

Mar 22, 2024

Sex

Male

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

Practice roles

Locations

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.

• Hand in Hand LLC

  • Primary Care Nurse Practitioner
  • Boise, ID
  • NPI 1154817021
  NPD

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

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1891555025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6305 W OVERLAND RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837093029",
            "telephone_number": "208-605-3663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6305 W OVERLAND RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837093029",
            "telephone_number": "208-605-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "TYRAY",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wayne R Peterson, D.M.D.
• Kelly Petrino, PSY.D
• Solomon Petros
• Nicky Petrou
• Sydnee Paige Petty
• Jeffrey A Pewe, P.A.
• Pfaff Chiropractic & Rehabilitation PLLC
• Brian Pfaff, CHIROPRACTOR
• Elissa Pfau, LPC
• Ryan Kurt Pfleger, PA-C

• Community Health Worker in Boise, ID
• Providers in Boise, ID by specialty
• Community Health Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.