Active NPI
Thuy Le Petersen, PAC
- Internal Medicine Physician
- Leavenworth, KS
National Provider Identifier
1285969667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 1089316
- Practice address
- 1300 Metropolitan Ave
Leavenworth, KS 66048 - Phone
- (913) 682-8700
- NPI assigned
- Oct 2, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 1089316 | MO | |
| Internal Medicine Physician | 207R00000X | 1089316 | MO | Primary |
Addresses
Primary practice location
1300 Metropolitan Ave
Leavenworth, KS 66048
Mailing address
5715 N Hull CT
Kansas City, MO 64151-2602
Phone (260) 418-3972
Other practice location 1
1102 W 32nd St
Joplin, MO 64804-3503
Phone (417) 347-5001
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1089316 | Other | MO | MISSOURI LICENSE NUMBER |
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1089316 | MO | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Usp Leavenworth | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Health Service Clinic/Center
- Leavenworth, KS
- NPI 1578907879
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562803200000",
"number": "1285969667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5715 N HULL CT",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641512602",
"telephone_number": "260-418-3972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 METROPOLITAN AVE",
"city": "LEAVENWORTH",
"state": "KS",
"postal_code": "66048",
"telephone_number": "913-682-8700"
}
],
"practiceLocations": [
{
"address_1": "1102 W 32nd St",
"address_purpose": "LOCATION",
"city": "Joplin",
"state": "MO",
"postal_code": "648043503",
"country_code": "US",
"telephone_number": "417-347-5001",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSEN",
"first_name": "THUY",
"middle_name": "LE",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-02",
"last_updated": "2019-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MO",
"license": "1089316",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "1089316",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSOURI LICENSE NUMBER",
"identifier": "1089316",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leavenworth, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.