Kelly Janell Petree

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

212074 Issued in OK

Practice address

9228 S Mingo Rd Ste 101&103
Tulsa, OK 74133-5718

Phone

(405) 378-2727

NPI assigned

Jan 10, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of OklahomaGroup PAC ID 4486558962, 99 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• State of Oklahoma

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Norman, OK
  • NPI 1588755532
  Medicare reassignment Care Compare group NPD
• State of Oklahoma

  • Skilled Nursing Facility
  • Talihina, OK
  • NPI 1154589430
  NPD
• State of Oklahoma

  • Psychiatric Hospital
  • Tulsa, OK
  • NPI 1578580916
  NPD
• Eustasis Foundation, Inc

  • Voluntary or Charitable Agency
  • Springfield, MO
  • NPI 1386257780
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1982244695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9228 S MINGO RD STE 101&103",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741335718",
            "telephone_number": "405-378-2727",
            "fax_number": "918-518-7258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9228 S MINGO RD STE 101&103",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741335718",
            "telephone_number": "405-378-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETREE",
        "first_name": "KELLY",
        "middle_name": "JANELL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-10",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2020000885",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OK",
            "license": "212074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420080198",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul David Peterson, M.D.
• Rowdy Adam Peterson
• Tara Peterson
• Timothy Kent Peterson, LPC, LMFT
• Jacqueline Petray, M.D.
• Seana Lynn Petri, MA, LPC, CRC
• Carmen Pettie
• Bruce Ben Pettigrove, M.D.
• Nicholas J Pettinelli, DO
• Haley Pettingell

• Psychiatric/Mental Health Nurse Practitioner in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.