Provider Demographics
NPI:1386613040
Name:NOBLETT, SUSAN T (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:NOBLETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLLEGE AVE
Mailing Address - Street 2:SUITE E-110
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2770
Mailing Address - Country:US
Mailing Address - Phone:785-537-2651
Mailing Address - Fax:785-537-4276
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:SUITE E-110
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-537-2651
Practice Address - Fax:785-537-2975
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74497363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100395280AMedicaid
KS068002180OtherMEDICARE PTAN
KS100395280BMedicaid
KS068002180OtherMEDICARE PTAN
KS160646Medicare ID - Type Unspecified