Individual
KESHIA PETTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10515 MALLARD CREEK RD, CHARLOTTE, NC 28262-9785
(704) 547-9739
Mailing address
10515 MALLARD CREEK RD, CHARLOTTE, NC 28262-9785
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5004129
NC
Other
Enumeration date
10/07/2008
Last updated
01/23/2009
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