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Individual

ANGELA MARIE PETTUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DNP

Contact information

Practice address
4125 STATE LINE RD, KANSAS CITY, MO 64111-4423
(913) 284-1889
Mailing address
12310 W 54TH ST, SHAWNEE, KS 66216-1402

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2022028087
MO
363L00000X
Nurse Practitioner
Primary
53-81365-091
KS
363LA2200X
Adult Health Nurse Practitioner
2022028087
MO
363LA2200X
Adult Health Nurse Practitioner
53-81365-091
KS
363LG0600X
Gerontology Nurse Practitioner
2022028087
MO
363LG0600X
Gerontology Nurse Practitioner
53-81365-091
KS

Other

Enumeration date
07/14/2022
Last updated
11/18/2025
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