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

Kristofer Kedar Pettway

Individual provider Prevention Professional · NPI 1427783315

Kristofer Kedar Pettway is a Prevention Professional in Los Angeles, California. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2022

Practice location Address checks out

411 S Normade Ave Apt 732
Los Angeles, CA 90020-3396
Phone: (516) 919-0061
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Prevention Professional (primary) Taxonomy 405300000X · Licence 19393832 (NY)

Record details

NPI number1427783315
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 23, 2022
Last updated in NPPESJuly 23, 2022
Certification dateJuly 23, 2022

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