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General NPI Number Information
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NPI Number | 1942514708
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Entity Type | Individual
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Provider Name | JASMINE KETTLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 3701 J ST SUITE # 109
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City | SACRAMENTO
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State | CA
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Zip | 95816-5562
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Country | US
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Telephone | 734-358-7418
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 J ST SUITE # 109
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City | SACRAMENTO
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State | CA
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Zip | 95816-5562
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Country | US
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Telephone | 734-358-7418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA21683
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License Number State | CA
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