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

Tyray M Petty

Individual provider Case Manager/Care Coordinator · NPI 1891555025

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 Rd
Boise, ID 83709-3029
Phone: (208) 605-3663
Show map & directions

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

Specialties & licences

Community Health Worker (primary) Taxonomy 172V00000X
Case Manager/Care Coordinator Taxonomy 171M00000X

Record details

NPI number1891555025
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 22, 2024
Last updated in NPPESMarch 22, 2024
Certification dateMarch 22, 2024
Mailing address6305 W Overland Rd, Boise, ID 83709-3029

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