1033736103 NPI number — JAMISON JOLENE KETTER MS PLMHP

Table of content: JAMISON JOLENE KETTER MS PLMHP (NPI 1033736103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033736103 NPI number — JAMISON JOLENE KETTER MS PLMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KETTER
Provider First Name:
JAMISON
Provider Middle Name:
JOLENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS PLMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHLEPPENBACH
Provider Other First Name:
JAMISON
Provider Other Middle Name:
JOLENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS PLMHP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033736103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2444 O ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68510-1125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-475-7666
Provider Business Mailing Address Fax Number:
402-476-9623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2444 O ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510-1125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-475-7666
Provider Business Practice Location Address Fax Number:
402-476-9623
Provider Enumeration Date:
07/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  12272 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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