Provider Demographics
NPI:1689325177
Name:JETTE, MAXWELL
Entity Type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:
Last Name:JETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST RM M-53
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-3983
Mailing Address - Country:US
Mailing Address - Phone:541-259-0235
Mailing Address - Fax:859-323-8056
Practice Address - Street 1:800 ROSE ST RM M-53
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-3983
Practice Address - Country:US
Practice Address - Phone:859-323-5083
Practice Address - Fax:859-323-8056
Is Sole Proprietor?:No
Enumeration Date:2022-01-16
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program