=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396558631
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAIGE MICHELLE PETITE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2025
-----------------------------------------------------
Last Update Date | 02/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 W RANDOLPH ST UNIT 1702
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-1435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-307-8043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 CLAY EDWARDS DRIVE, CENTRAL VERIFICATION OFFICE AND PAYOR ENROLLMENT
-----------------------------------------------------
City | NORTH KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-691-1655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 2026006522
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------