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Contact Information

JAMIE L KETTERMAN, RN, BSN, CDE
1602 N 2ND ST
CLINTON, MO64735-1192
 Phone: 660-885-8171
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
 

Diabetes Educator

163WD0400X
Indicates primary specialty

NPI Profile & details for JAMIE L KETTERMAN · (Female)

NPI Number 1609087402
Status Active
Credentials RN, BSN, CDE
Entity Individual
Enumeration date 05/24/2007
Last updated 11/16/2021 - About 5 years ago
Sole proprietor 1 Yes
Identifiers
  • MO License # 2000162289
  • MO License # 2014022528
  • MO Medicaid 357499904
Hospital affiliation(s)
  • GOLDEN VALLEY MEMORIAL HOSPITAL - (Acute Care)
    1600 N 2ND ST
    CLINTON, MO 64735
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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