=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548941859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHWAYS INTEGRATIVE MEDICINE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2023
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 HILL ST STE B
-----------------------------------------------------
City | RED WING
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55066-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-281-8531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 HILL ST STE B
-----------------------------------------------------
City | RED WING
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55066-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-281-8531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SCOTT KETTERLING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-385-5999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------