Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

TYRAY M PETTY
NPI 1891555025
Case Manager/Care Coordinator in Boise, ID

Q: What is Tyray Petty's NPI number?

The NPI number for Tyray Petty is 1891555025. It was assigned to this individual provider in the NPPES registry on March 22, 2024.

Q: What is Tyray Petty's specialty?

The primary specialty registered for this NPI is Case Manager/Care Coordinator with taxonomy code 171M00000X.

Q: When was this NPI record last updated?

The NPPES record for Tyray Petty was last updated on October 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 days 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.

Active since March 22, 2024

148 S COLE RD, BOISE, ID 83709(208) 605-3663(208) 969-8380 Get Directions Write a Review

NPPES record last updated: October 26, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Tyray M Petty NPPES

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

TYRAY M PETTY (NPI 1891555025) is an individual case manager/care coordinator provider in Boise, Idaho and active in the NPI registry since March 2024.

NPPES Registry Identity

NPI1891555025

Entity TypeIndividualMale

Primary Taxonomy171M00000X

Provider Legal NameTYRAY M PETTY

Location Address148 S COLE RDBoise, ID 83709-0932

Mailing Address148 S Cole RdBoise, ID 83709-0932 · (208) 605-3663 · Fax (208) 969-8380

Phone(208) 605-3663

Fax(208) 969-8380

Sole ProprietorNo

Enumeration DateMarch 22, 2024

Last NPPES UpdateOctober 26, 2026

NPPES CertifiedOctober 26, 2026

✔ NPI 1891555025 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCase Manager/Care CoordinatorOther Service Providers

Taxonomy Code171M00000X

Definition

A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee's progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management.

Also ListedCommunity Health WorkerTaxonomy 172V00000X

148 S COLE RD, Boise, ID 83709

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHELSEA LOUISE LAFEE LMSW

Social Worker

148 S COLE RD
BOISE, ID 83709

Ada County (208) 683-8320

KENNA BOLEN LPC, CM, CBRS

Counselor (Professional)

148 S COLE RD
BOISE, ID 83709

Ada County (208) 683-8320

SHARIAH MICHELLE PHILLIPS

Case Manager/Care Coordinator

148 S COLE RD
BOISE, ID 83709

Ada County (208) 683-8320

BREAYDYN PAYGE ANGLIN

Case Manager/Care Coordinator

148 S COLE RD
BOISE, ID 83709

Ada County (208) 683-8320

ALLISON NICOLE VAN DER VEEN

Case Manager/Care Coordinator

148 S COLE RD
BOISE, ID 83709

Ada County (208) 683-8320

MIRANDA MURPHY

Student in an Organized Health Care Education/Training Program

148 S COLE RD
BOISE, ID 83709

Ada County (208) 683-8320

JUDITH CARON LCSW

Social Worker (Clinical)

148 S COLE RD
BOISE, ID 83709

Ada County (208) 683-8320

MADISON M HENSON

Social Worker

148 S COLE RD
BOISE, ID 83709

Ada County (208) 683-8320

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 Tyray Petty's NPI number?

The NPI number for Tyray Petty is 1891555025. It was assigned to this individual provider in the NPPES registry on March 22, 2024.

Where is Tyray Petty located?

Tyray Petty practices at 148 S Cole Rd, Boise, ID 83709. The listed phone number is (208) 605-3663.

What is Tyray Petty's specialty?

The primary specialty registered for this NPI is Case Manager/Care Coordinator with taxonomy code 171M00000X.

When was this NPI record last updated?

The NPPES record for Tyray Petty was last updated on October 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 days 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.