Individual
JEROME L PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9 WALDEN RIDGE DR STE 10, ASHEVILLE, NC 28803-8592
(833) 365-7246
Mailing address
PO BOX 602229, CHARLOTTE, NC 28260-2229
(828) 894-3718
(828) 894-3806
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103720
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0816PA
—
SC
05
—
1861587560
—
NC
01
—
27671
MEDCOST PROVIDER NUMBER
NC
05
—
8102639
—
NC
01
—
970030947
MEDICARE RR PROVIDER NUMB
NC
Enumeration date
10/04/2006
Last updated
04/08/2026
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