Provider Demographics
NPI:1841822343
Name:JUCKETT, MICHELLE LYNN (APN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:JUCKETT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 MILL ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9301
Mailing Address - Country:US
Mailing Address - Phone:609-790-1111
Mailing Address - Fax:
Practice Address - Street 1:1640 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-9247
Practice Address - Country:US
Practice Address - Phone:973-661-8300
Practice Address - Fax:973-661-8333
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01013400363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology