MRS. DAWN LYNETTE PETTY, N.P. - NPI NUMBER 1134404957

Summary

Provider Name: MRS. DAWN LYNETTE PETTY, N.P.

NPI Number: 1134404957

Clasification: Nurse Practitioner (363L00000X)

Organization: KANSAS CITY INTERNAL MEDICINE APC

Address:
20 NE SAINT LUKES BOULEVARD
SUITE #350
LEE'S SUMMIT, MO
ZIP 64086

Phone Number: (816) 524-5333



Detailed Information

MRS. Dawn Lynette Petty, N.P. is a nurse practitioner in Lee's Summit, MO with 3 years of experience. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. The assigned NPI number for this provider is 1134404957 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

20 NE SAINT LUKES BOULEVARD
SUITE #350
LEE'S SUMMIT, MO
ZIP 64086-007
Phone: (816) 524-5333
Fax: (816) 524-4325

The enumeration date for this NPI number is 10/12/2011 and was last updated on 10/12/2011.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 363L00000X Nurse Practitioner 53-75468-111 KS Yes

NPI Record

No. Field Name Field Value
1 NPI 1134404957
2 Entity Type Code 1
3 Provider Last Name Legal Name PETTY
4 Provider First Name DAWN
5 Provider Middle Name LYNETTE
6 Provider Name Prefix Text MRS.
7 Provider Credential Text N.P.
8 Provider Other Last Name HARRIS
9 Provider Other First Name DAWN
10 Provider Other Middle Name LYNETTE
11 Provider Other Name Prefix Text MISS
12 Provider Other Credential Text RN
13 Provider Other Last Name Type Code 1
14 Provider First Line Business Practice Location Address 20 NE SAINT LUKES BOULEVARD
15 Provider Second Line Business Practice Location Address SUITE #350
16 Provider Business Practice Location Address City Name LEE'S SUMMIT
17 Provider Business Practice Location Address State Name MO
18 Provider Business Practice Location Address Postal Code 640866007
19 Provider Business Practice Location Address Country Code If outside U S US
20 Provider Business Practice Location Address Telephone Number 8165245333
21 Provider Business Practice Location Address Fax Number 8165244325
22 Provider Enumeration Date 10/12/2011
23 Last Update Date 10/12/2011
24 Provider Gender Code F
25 Healthcare Provider Taxonomy Code 1 363L00000X
26 Provider License Number 1 53-75468-111
27 Provider License Number State Code 1 KS
28 Healthcare Provider Primary Taxonomy Switch 1 Y
29 Is Sole Proprietor N

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This page was last updated on: 4/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.