Provider Demographics
NPI:1144221656
Name:BITTLE, JUANITA J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:J
Last Name:BITTLE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1301 W 12TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2590
Mailing Address - Country:US
Mailing Address - Phone:620-343-2376
Mailing Address - Fax:620-343-0095
Practice Address - Street 1:537 S FREEBORN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KS
Practice Address - Zip Code:66861-1256
Practice Address - Country:US
Practice Address - Phone:620-382-2033
Practice Address - Fax:877-409-1174
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00415363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100406940CMedicaid
KSR32094Medicare UPIN