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Individual
LAINEY MEDINE PETTY
Active
Individual
LAINEY MEDINE PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.2002.39RX
LA
363A00000X
Physician Assistant
Primary
PA9107181
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1357103
—
LA
Enumeration date
08/06/2008
Last updated
06/22/2020
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