Individual
JAMIE L. KETTERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN, CDE
Contact information
Practice address
1602 N 2ND ST, CLINTON, MO 64735-1192
(660) 885-8171
Mailing address
1602 N 2ND ST, CLINTON, MO 64735-1192
(660) 885-8171
(660) 890-8422
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
2000162289
MO
363LF0000X
Family Nurse Practitioner
Primary
2014022528
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
357499904
—
MO
Enumeration date
05/24/2007
Last updated
11/16/2021
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