Provider Demographics
NPI:1699497107
Name:PETTY, MICHELLE PARIS (DNP-FNP)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:PARIS
Last Name:PETTY
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 S COMPASS LN
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-9526
Mailing Address - Country:US
Mailing Address - Phone:252-256-1922
Mailing Address - Fax:252-255-6352
Practice Address - Street 1:50347 NC-12 HWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:NC
Practice Address - Zip Code:27936
Practice Address - Country:US
Practice Address - Phone:252-261-3041
Practice Address - Fax:252-255-6352
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily