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NPI Code Detail

MEDICARE: JUSTIN KETTELL FNP

MEDICARE: JUSTIN KETTELL FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF05260376DC

General Provider Information

NPI Number : 1346174273
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN KETTELL FNP
Provider Business Mailing Address
First Line : 3600 CUMBERLAND AVE
Second Line :
City : WACO
State : TX
Zip : 76707-1106
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4414 BENNING RD NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-4555
Country : US
Telephone Number : 202-469-4699
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/08/2026

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