Basic Information
| Provider Information | |||||||||
| NPI: | 1477532836 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOEL | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | DNP, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF KY DEPARTMENT OF PEDIATRICS | ||||||||
| Address2: | 800 ROSE STREET MN 150 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593232942 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1135 HARRY SYKES WAY | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405041383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592182273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 3002148 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0200X | 3002148 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 78001468 | 05 | KY | MEDICAID |