Provider Demographics
NPI:1518994755
Name:PETTY, DEBORAH (RN MSN ARNP CCRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PETTY
Suffix:
Gender:F
Credentials:RN MSN ARNP CCRN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:MACKISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20805 W 151ST ST
Mailing Address - Street 2:BLDG 2 STE 400
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5353
Mailing Address - Country:US
Mailing Address - Phone:913-780-4900
Mailing Address - Fax:913-780-0949
Practice Address - Street 1:20805 W 151ST ST
Practice Address - Street 2:BLDG 2 STE 400
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5353
Practice Address - Country:US
Practice Address - Phone:913-780-4900
Practice Address - Fax:913-780-0949
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74827363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner