Individual
KETTLYNE KETTLYNE EXAMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11113 LAKE TAHOE DR # 111, RIVERVIEW, FL 33569-2927
(813) 466-9076
Mailing address
11113 LAKE TAHOE DR # 111, RIVERVIEW, FL 33569-2927
(813) 466-9076
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
FL
01
—
NA
NA
—
Enumeration date
03/29/2021
Last updated
03/29/2021
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