Individual
MS. KALLY ANN PETKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
100 SOUTH ST, SOUTHBRIDGE, MA 01550-4051
(508) 765-9771
Mailing address
100 SOUTH ST STE 1, SOUTHBRIDGE, MA 01550-4047
(508) 765-9771
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN2277628
MA
363LF0000X
Family Nurse Practitioner
Primary
RN2277628
MA
Other
Enumeration date
02/10/2020
Last updated
01/30/2025
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