Provider Demographics
NPI:1013754282
Name:PETTIT, NATHAN HAROLD III (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:HAROLD
Last Name:PETTIT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5908 ROCKHILL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3116
Mailing Address - Country:US
Mailing Address - Phone:501-747-7269
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD # MS 3016
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-6977
Practice Address - Country:US
Practice Address - Phone:501-747-7269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2025-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS94-12373208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology