Provider Demographics
NPI:1679740997
Name:PETTIGREW, NEVA JO (FNP)
Entity type:Individual
Prefix:
First Name:NEVA
Middle Name:JO
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NEVA
Other - Middle Name:JO
Other - Last Name:STRICKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1314 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4116
Mailing Address - Country:US
Mailing Address - Phone:601-703-4282
Mailing Address - Fax:601-703-4597
Practice Address - Street 1:1710 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4140
Practice Address - Country:US
Practice Address - Phone:601-703-1485
Practice Address - Fax:601-703-1488
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR684899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01758833Medicaid
MS01758833Medicaid