Healthcare Provider Details

I. General information

NPI: 1548941859
Provider Name (Legal Business Name): HEALTHWAYS INTEGRATIVE MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HILL ST STE B
RED WING MN
55066-2363
US

IV. Provider business mailing address

111 HILL ST STE B
RED WING MN
55066-2363
US

V. Phone/Fax

Practice location:
  • Phone: 612-281-8531
  • Fax:
Mailing address:
  • Phone: 612-281-8531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KETTERLING
Title or Position: OWNER
Credential:
Phone: 651-385-5999