Individual ProviderTierra PettwayLicensed Practical NurseNursing Service ProvidersPractice Address53 Academy St, Patchogue, NY 11772-3821(516) 410-4896PECOS EnrollmentBased on the most recent information from CMS, provider Tierra Pettway does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1073491783Provider TypeIndividualFull NamePettway, TierraGenderFemaleSole ProprietorNoEnumeration Date8/22/2025Last Updated8/22/2025Contact InformationPractice LocationPractice Address53 Academy St, Patchogue, NY 11772-3821Phone(516) 410-4896FaxUnlisted FaxMailing LocationMailing Address53 Academy St, Patchogue, NY 11772-3821Phone(516) 410-4896FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense292164New York