Provider Demographics
NPI:1588188791
Name:JETER, NADIA E (LSW)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:E
Last Name:JETER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:EMELIA
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 SKYLAND SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31315
Mailing Address - Country:US
Mailing Address - Phone:904-252-1597
Mailing Address - Fax:
Practice Address - Street 1:140 SKYLAND SPRUCE DR
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31315
Practice Address - Country:US
Practice Address - Phone:904-252-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker