Provider Demographics
NPI:1609326024
Name:PETTINGER, DENISE (FNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:PETTINGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-1573
Mailing Address - Country:US
Mailing Address - Phone:931-954-5219
Mailing Address - Fax:
Practice Address - Street 1:115 N WOODLAND ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1573
Practice Address - Country:US
Practice Address - Phone:931-954-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36914363LF0000X
CA95005270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily