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General NPI Number Information
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NPI Number | 1336873371
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Entity Type | Individual
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Provider Name | ANGELA MARIE PETTUS DNP
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Gender | Female
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 4125 STATE LINE RD
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City | KANSAS CITY
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State | MO
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Zip | 64111-4423
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Country | US
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Telephone | 913-284-1889
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Fax |
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Provider Business Mailing Address
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Address Line | 12310 W 54TH ST
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City | SHAWNEE
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State | KS
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Zip | 66216-1402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 53-81365-091
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2022028087
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 53-81365-091
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2022028087
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2022028087
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License Number State | MO
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Taxonomy #6
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 53-81365-091
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License Number State | KS
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