Healthcare Provider Details

I. General information

NPI: 1265660872
Provider Name (Legal Business Name): KATHRYN LOUISE PETELIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN LOUISE THOMPSON DO

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 RENNER RD
SHAWNEE KS
66217-9414
US

IV. Provider business mailing address

2106 OLATHE BLVD MS 4004
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6300
  • Fax: 913-274-3515
Mailing address:
  • Phone: 913-588-6300
  • Fax: 913-274-3515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-07215
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number05-35594
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: