Provider Demographics
NPI:1144892936
Name:JETT, JOSEPH NATHAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:NATHAN
Last Name:JETT
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2031 SE MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9326
Mailing Address - Country:US
Mailing Address - Phone:316-990-1308
Mailing Address - Fax:
Practice Address - Street 1:2051 KAEN RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4035
Practice Address - Country:US
Practice Address - Phone:503-650-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR201902472NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner