Individual
LEONORA K PETTY
Active
Individual
LEONORA K PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
P6242
TX
2084P0804X
Child & Adolescent Psychiatry Physician
20578
MS
2084P0804X
Child & Adolescent Psychiatry Physician
MD035524L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04428702
—
MS
05
—
1014016060001
—
PA
05
—
109062
—
AL
01
—
302I269052
MEDICARE
MS
Enumeration date
05/17/2006
Last updated
04/20/2022
Update your record
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