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TIERRA PETTWAY
NPI 1073491783
Licensed Practical Nurse in Patchogue, NY

Active since August 22, 2025
53 ACADEMY ST, PATCHOGUE, NY 11772(516) 410-4896 Get Directions Write a Review

NPPES record last updated: August 22, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Tierra Pettway NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIERRA PETTWAY (NPI 1073491783) is an individual licensed practical nurse in Patchogue, New York, licensed in New York (292164) and active in the NPI registry since August 2025.

NPPES Registry Identity

NPI1073491783
Entity TypeIndividualFemale
Primary Taxonomy164W00000X
Provider Legal NameTIERRA PETTWAY
Location Address53 ACADEMY STPatchogue, NY 11772-3821
Mailing Address53 Academy StPatchogue, NY 11772-3821 · (516) 410-4896
Phone(516) 410-4896
Sole ProprietorNo
Enumeration DateAugust 22, 2025
NPPES CertifiedAugust 22, 2025
✔ NPI 1073491783 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in NY · 292164
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
53 ACADEMY ST, Patchogue, NY 11772
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tierra Pettway's NPI number?

The NPI number for Tierra Pettway is 1073491783. It was assigned to this individual provider in the NPPES registry on August 22, 2025.

Where is Tierra Pettway located?

Tierra Pettway practices at 53 Academy St, Patchogue, NY 11772. The listed phone number is (516) 410-4896.

What is Tierra Pettway's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Tierra Pettway was last updated on August 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.