MEDICARE: MS. JUANITA J. BITTLE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	15-00415	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144221656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUANITA J. BITTLE PA-C

Provider Business Mailing Address
First Line	:	1301 W 12TH AVE STE 301
Second Line	:
City	:	EMPORIA
State	:	KS
Zip	:	66801-2590
Country	:	US
Telephone Number	:	620-343-2376
Fax Number	:	620-343-0095

Provider Business Practice Location Address
First Line	:	537 S FREEBORN ST
Second Line	:
City	:	MARION
State	:	KS
Zip	:	66861-1256
Country	:	US
Telephone Number	:	620-382-2033
Fax Number	:	877-409-1174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	10/17/2023

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