Provider Demographics
NPI:1093609778
Name:PETTY, MARCIA IRENE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:IRENE
Last Name:PETTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARCIA
Other - Middle Name:IRENE
Other - Last Name:WELBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4900 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1233
Mailing Address - Country:US
Mailing Address - Phone:913-207-2651
Mailing Address - Fax:
Practice Address - Street 1:2000 OLATHE BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8505
Practice Address - Country:US
Practice Address - Phone:913-588-8147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23-41298-032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse