Provider Demographics
NPI:1205973054
Name:PETTY, JULIE LYNN
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:LYNN
Last Name:PETTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 E PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3373
Mailing Address - Country:US
Mailing Address - Phone:913-269-3887
Mailing Address - Fax:
Practice Address - Street 1:428 E PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3373
Practice Address - Country:US
Practice Address - Phone:913-269-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide