Healthcare Provider Details

I. General information

NPI: 1184247231
Provider Name (Legal Business Name): JEREMIAH NOE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2020
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD
LEXINGTON KY
40504-3516
US

IV. Provider business mailing address

110 VILLAGE PKWY
NICHOLASVILLE KY
40356-2327
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-9255
  • Fax: 859-257-3585
Mailing address:
  • Phone: 859-887-8400
  • Fax: 859-885-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC949
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2699
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2699
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2699
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: