Individual
MS. ANITA PETITTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1400 HOSPITAL DR, HURRICANE, WV 25526-9202
(304) 757-1767
(304) 757-1716
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00844
WV
363A00000X
Physician Assistant
315
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001796236
BLUE CROSS BLUE SHIELD
WV
01
—
1065295
WV DWC
WV
Enumeration date
05/29/2007
Last updated
11/13/2008
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