Active NPI
Kelsey Petrie
- Gynecology Physician
- Spokane, WA
National Provider Identifier
1215460704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- MD61151121
- Practice address
- 4815 N Assembly St
Spokane, WA 99205-6185 - Phone
- (509) 434-7000
- NPI assigned
- Apr 11, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | MD61151121 | WA | Primary |
Addresses
Primary practice location
4815 N Assembly St
Spokane, WA 99205-6185
Mailing address
4815 N Assembly St
Spokane, WA 99205-6185
Phone (509) 434-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD61151121 | WA | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729555200000",
"number": "1215460704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4815 N ASSEMBLY ST",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992056185",
"telephone_number": "509-434-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4815 N ASSEMBLY ST",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992056185",
"telephone_number": "509-434-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRIE",
"first_name": "KELSEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-11",
"last_updated": "2024-10-22",
"certification_date": "2024-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "WA",
"license": "MD61151121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.