Petty, Lainey Medine

Petty, Lainey Medine is an individual health care provider with primary practice located at 307 Boatner Rd Ste 114 , Eglin Afb FL 32542-1302. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Petty, Lainey Medine can be contacted via phone (850) 883-8600.

Contact Information

Primary practice address
307 Boatner Rd Ste 114 Eglin Afb FL 32542-1302
Phone: (850) 883-8600
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA.2002.39RX Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9107181 Florida

Profile Details

NPI number 1053577213
LBN Legal business name Petty, Lainey Medine
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 6th, 2008
Last updated Jun 22nd, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053577213 NPPES
Louisiana MEDICAID 1357103

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