Healthcare Provider Details

I. General information

NPI: 1336873371
Provider Name (Legal Business Name): ANGELA MARIE PETTUS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 MARSHALL DR STE 200
LENEXA KS
66214-9836
US

IV. Provider business mailing address

8550 MARSHALL DR STE 200
LENEXA KS
66214-9836
US

V. Phone/Fax

Practice location:
  • Phone: 913-495-2000
  • Fax: 913-495-3715
Mailing address:
  • Phone: 913-495-2000
  • Fax: 913-495-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number53-81365-091
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number53-81365-091
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-81365-091
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2022028087
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2022028087
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2022028087
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: