Provider Demographics
NPI:1265936454
Name:JETER, ANGELA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:JETER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3471 WOOLPER RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41080-9764
Mailing Address - Country:US
Mailing Address - Phone:859-699-2463
Mailing Address - Fax:
Practice Address - Street 1:3471 WOOLPER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:KY
Practice Address - Zip Code:41080-9764
Practice Address - Country:US
Practice Address - Phone:859-699-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily