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: CARONDELET PHYSICIAN SERVICES, INC.

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 4 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

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 Field Definition 1
1 NPI 1134404957 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name PETTY The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name DAWN The first name of the provider, if the provider is an individual.
5 Provider Middle Name LYNETTE The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text MRS. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text N.P. The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider Other Last Name HARRIS Other last name by which the provider being identified is or has been known.
9 Provider Other First Name DAWN Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only.
10 Provider Other Middle Name LYNETTE Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider middle name’’ if the provider is or has been known by a different last name only.
11 Provider Other Name Prefix Text MISS The other name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
12 Provider Other Credential Text RN The other abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
13 Provider Other Last Name Type Code 1 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
14 Provider First Line Business Practice Location Address 20 NE SAINT LUKES BOULEVARD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
15 Provider Second Line Business Practice Location Address SUITE #350 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
16 Provider Business Practice Location Address City Name LEE'S SUMMIT The city name in the location address of the provider being identified.
17 Provider Business Practice Location Address State Name MO The State code in the location of the provider being identified.
18 Provider Business Practice Location Address Postal Code 640866007 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
19 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
20 Provider Business Practice Location Address Telephone Number 8165245333 The telephone number associated with the location address of the provider being identified.
21 Provider Business Practice Location Address Fax Number 8165244325 The fax number associated with the location address of the provider being identified.
22 Provider Enumeration Date 10/12/2011 The date the provider was assigned a unique identifier (assigned an NPI).
23 Last Update Date 10/12/2011 The date that a record was last updated or changed.
24 Provider Gender Code F The code designating the provider’s gender if the provider is a person.
25 Healthcare Provider Taxonomy Code 1 363L00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
26 Provider License Number 1 53-75468-111 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
27 Provider License Number State Code 1 KS The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
28 Healthcare Provider Primary Taxonomy Switch 1 Y
29 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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