Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Irina Sergeevna Petty, PA

Individual provider Physician Assistant · NPI 1619211463

Irina Sergeevna Petty, PA is a Physician Assistant in Newark, Ohio. Qualified in 2012, 14 years ago. Practices with Licking Memorial Professional Corporation, a 235-clinician group and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
14
Licensed in
OH
In the registry since
2012
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

2000 Tamarack Rd
Newark, OH 43055
Phone: (220) 564-4650
Fax: (220) 564-4238
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 003613 (OH)

Record details

NPI number1619211463
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorYes
NPI enumeratedNovember 17, 2012
Last updated in NPPESApril 2, 2021
Certification dateApril 2, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Licking Memorial Professional Corporation — 235 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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