Provider Demographics
NPI:1316956014
Name:JETER, JOSEPH EDWARD (PA-C, MPAS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:JETER
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Gender:M
Credentials:PA-C, MPAS
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Mailing Address - Street 1:3911 AVENUE B
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4617
Mailing Address - Country:US
Mailing Address - Phone:308-630-2100
Mailing Address - Fax:308-630-2138
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:SUITE 1100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-630-2100
Practice Address - Fax:308-630-2138
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE355363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE970017216OtherRR MEDICARE
NE970017216OtherRR MEDICARE
NE266014Medicare UPIN