ELVY PETTIT JR. (NPI# 1972775427) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972775427 |
| Entity Type | Individual |
| Full Name | ELVY PETTIT JR. |
| Credential | P.A. |
| Practice Address |
3080 Trenwest Dr The Salem Center Winston Salem NC 27103-3208 |
| Practice Telephone | 3367680496 |
| Practice Fax Number | 3367680498 |
| Mailing Telephone | 3367680496 |
| Mailing Fax Number | 3367680498 |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
101961 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3080 TRENWEST DR THE SALEM CENTER |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-3208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073564399 | Jaime E Trujillo | Internal Medicine | 3080 Trenwest Dr, Winston Salem, NC 27103-3223 | 2006-05-12 |
| 1376005942 | Selby Gage Rouch | Physician Assistant | 3080 Trenwest Dr, Winston Salem, NC 27103-3208 | 2019-04-03 |
| 1942779475 | Liliana Pitu | Nurse Practitioner | 3080 Trenwest Dr, Winston Salem, NC 27103-3208 | 2018-11-14 |
| 1265604714 | Elisabeth Marie Motsinger | Physician Assistant | 3080 Trenwest Dr, The Salem Center, Winston Salem, NC 27103-3208 | 2008-03-25 |
| 1205850591 | Jennifer Fuqua | Physician Assistant | 3080 Trenwest Dr, Winston Salem, NC 27103-3208 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629692439 | Julie Anne Augustine | Physician Assistant | 718 S Green St, Winston Salem, NC 27101-5112 | 2020-06-08 |
| 1932674090 | Erin Baxter Caldwell | Physician Assistant | 2953 Buena Vista Rd, Winston Salem, NC 27106-5724 | 2018-10-04 |
| 1376054106 | Tara Mckenzie | Physician Assistant | 1 Medical Center Blvd Hosptial Medicine, Winston Salem, NC 27157-0001 | 2017-10-19 |
| 1154866382 | Camilla Potts Leonard | Physician Assistant | 503 Thurston St, Winston Salem, NC 27103-1609 | 2016-12-26 |
| 1427591379 | Darrell Justin Ratcliffe | Physician Assistant | 1500 W Academy St, Winston Salem, NC 27103-3849 | 2016-11-27 |
| 1881825917 | Mark Elno Archambault | Physician Assistant | Department of Physician Assistant Studies, Medical Center Blvd, Winston Salem, NC 27157-1006 | 2009-08-06 |
| 1659519551 | John Clifton Harper Jr. | Physician Assistant | 206 W Clemmonsville Rd, Winston Salem, NC 27127-5124 | 2009-01-30 |
| 1710070602 | John Joseph Dewar Sr. | Physician Assistant | 1399 Ashleybrook Ln Ste 100, Winston Salem, NC 27103-2961 | 2006-10-02 |
| 1871515866 | Beth Gurley | Physician Assistant | 765 Highland Oaks Dr, Suite 100, Winston Salem, NC 27103-7101 | 2006-07-25 |
| 1801845722 | Mark A Pane | Physician Assistant | 3333 Brookview Hills Blvd Ste 104, Winston Salem, NC 27103-5661 | 2006-05-08 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.