Individual
PATRICIA KETLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, APRN, BC
Contact information
Practice address
104 PLUMTREE RD, SUITE 115, BEL AIR, MD 21015-6095
(410) 515-4300
(410) 515-4318
Mailing address
638 RECKORD RD, FALLSTON, MD 21047-2443
(410) 879-3431
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R053356
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016
CAREFIRST DC
—
01
—
039889
JOHNS HOPKINS HEALTHCARE
—
01
—
110835
COVENTRY
—
01
—
250391
KAISER
—
05
—
521304500
—
MD
01
—
61318201
CAREFIRST MARYLAND
—
01
—
691571
NCPPO
—
05
—
93119
—
MD
Enumeration date
07/14/2006
Last updated
07/09/2007
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