MEDICARE: KETTIA NOEL

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	376J00000X	Homemaker	237322	FL
2	372600000X	Adult Companion		FL
3	261QD1600X	Developmental Disabilities Clinic/Center	L20000294693	FL

General Provider Information

NPI Number	:	1891395430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KETTIA NOEL

Provider Business Mailing Address
First Line	:	11582 SW VILLAGE PKWY
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34987-2392
Country	:	US
Telephone Number	:	772-233-5976
Fax Number	:

Provider Business Practice Location Address
First Line	:	1573 SE CLEARBROOK ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-4050
Country	:	US
Telephone Number	:	561-503-3273
Fax Number	:

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

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	03/04/2026

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Directions to “ KETTIA NOEL ” Practice Location

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