Active NPI
Ann M Petry, SLP
- Speech-Language Pathologist
- Omaha, NE
National Provider Identifier
1265499529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1155
- Practice address
- 11163 Hanover St
Omaha, NE 68142-1519 - Phone
- (402) 496-6396
- NPI assigned
- Apr 28, 2006
- Last updated
- Feb 19, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 1155 | NE | Primary |
Addresses
Primary practice location
11163 Hanover St
Omaha, NE 68142-1519
Mailing address
11163 Hanover St
Omaha, NE 68142-1519
Phone (402) 496-6396
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025593900 | Medicaid | NE |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1155 | NE | MD | Community Health/Public Health Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203379200000",
"number": "1265499529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11163 HANOVER ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681421519",
"telephone_number": "402-496-6396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11163 HANOVER ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681421519",
"telephone_number": "402-496-6396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRY",
"first_name": "ANN",
"middle_name": "M",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-28",
"last_updated": "2008-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NE",
"license": "1155",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025593900",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.