Provider Demographics
NPI:1255213302
Name:PETTY, TAMRA L
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:L
Last Name:PETTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMRA
Other - Middle Name:L
Other - Last Name:WITTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2911
Mailing Address - Country:US
Mailing Address - Phone:559-901-9830
Mailing Address - Fax:
Practice Address - Street 1:411 W 9TH ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2911
Practice Address - Country:US
Practice Address - Phone:559-901-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH135138653747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant