Provider Demographics
NPI:1124609078
Name:PETTY, AMY JIAYUE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:JIAYUE
Last Name:PETTY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:JIAYUE
Other - Middle Name:
Other - Last Name:DENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MAILSTOP 2025
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-1227
Mailing Address - Fax:
Practice Address - Street 1:10740 NALL AVE # LEVEL3
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1367
Practice Address - Country:US
Practice Address - Phone:913-588-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025006496207N00000X
KS04-51339207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty