Individual
MR. KEITH WESLEY KETTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4320 SEMINARY RD, ALEXANDRIA, VA 22304-1535
(703) 504-3000
Mailing address
8424 BLAKISTON LN, ALEXANDRIA, VA 22308-2104
(703) 619-5993
(703) 619-1566
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001008
VA
Other
Enumeration date
11/04/2005
Last updated
07/08/2007
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