Tyray M Petty
Tyray M Petty is a Case Manager/Care Coordinator in Boise, Idaho. Registered with an NPI since 2024.
- In the registry since
- 2024
- Specialties on file
- 2
Practice location Address checks out
6305 W Overland RdBoise, ID 83709-3029
Phone: (208) 605-3663
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Specialties & licences
| Community Health Worker (primary) | Taxonomy 172V00000X |
|---|---|
| Case Manager/Care Coordinator | Taxonomy 171M00000X |
Record details
| NPI number | 1891555025 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | March 22, 2024 |
| Last updated in NPPES | March 22, 2024 |
| Certification date | March 22, 2024 |
| Mailing address | 6305 W Overland Rd, Boise, ID 83709-3029 |
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