# DEBRA KETTLESON INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134525546
- **Authorized official:** DEBRA LYNN KETTLESON (OWNER/PROVIDER)
- **Authorized official phone:** (808) 365-5988

## Contact information

- **Practice address:** 670 PONAHAWAI ST STE 221, HILO, HI 96720-7829
- **Practice address phone:** (808) 365-5988
- **Practice address fax:** (808) 365-5989
- **Mailing address:** 670 PONAHAWAI ST STE 221, HILO, HI 96720-7829
- **Mailing address phone:** (808) 365-5988
- **Mailing address fax:** (808) 365-5989

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0381075 | HI | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | 2009004214 | HI | — |

## Other

- **Enumeration date:** 11/12/2014
- **Last updated:** 01/05/2015