Provider Demographics
NPI:1417028085
Name:JETT, MARCIA (ARNP-CDE)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:JETT
Suffix:
Gender:F
Credentials:ARNP-CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:110 S SALEM DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1761
Practice Address - Country:US
Practice Address - Phone:502-350-5081
Practice Address - Fax:502-349-4745
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003072363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP15779Medicare UPIN
KY00522001Medicare PIN