Provider Demographics
NPI:1184247231
Name:NOE, JEREMIAH (PA)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:NOE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2327
Mailing Address - Country:US
Mailing Address - Phone:859-887-8400
Mailing Address - Fax:859-885-8448
Practice Address - Street 1:2195 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3516
Practice Address - Country:US
Practice Address - Phone:859-257-9255
Practice Address - Fax:859-257-3585
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-23
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC949363A00000X
KYPA2699363AM0700X, 363AS0400X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program