Petty, Tyray M

Petty, Tyray M is an individual health care provider with primary practice located at 6305 W Overland Rd , Boise ID 83709-3029. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Other Service Providers / Community Health Worker. Other Service Providers / Community Health Worker is his primary health care specialty. Petty, Tyray M can be contacted via phone (208) 605-3663.

Contact Information

Primary practice address
6305 W Overland Rd Boise ID 83709-3029
Phone: (208) 605-3663
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Other Service Providers / Community Health Worker 172V00000X

Profile Details

NPI number 1891555025
LBN Legal business name Petty, Tyray M
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 22nd, 2024
Last updated Mar 22nd, 2024 - about 9 months 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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