Provider Demographics
NPI:1235379702
Name:JUETT, NOEL (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:JUETT
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3213 SUMMIT SQUARE PL
Practice Address - Street 2:# 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2651
Practice Address - Country:US
Practice Address - Phone:859-381-1066
Practice Address - Fax:859-263-0650
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005954363L00000X, 367A00000X
SC25766367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100053490Medicaid
KY7100092780Medicaid
KY0783108Medicare PIN
KYK088270Medicare PIN
KY7831Medicare PIN