# MR. MADISON D PETTIGREW

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1912211764
- **Gender:** Man
- **Credential:** MSN, APN, PMHNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | 171949 | TN | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 28484 | TN | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 904213 | MS | — |

## Other

- **Enumeration date:** 08/04/2010
- **Last updated:** 08/01/2023