MEDICARE: SAVANNAH D KETTERER PA-C

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1962005819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH D KETTERER PA-C

Provider Business Mailing Address
First Line	:	3024 BUSINESS PARK CIR
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-3132
Country	:	US
Telephone Number	:	615-239-2018
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 HUNT CLUB BLVD STE 100
Second Line	:
City	:	GALLATIN
State	:	TN
Zip	:	37066-6070
Country	:	US
Telephone Number	:	615-822-2177
Fax Number	:	615-822-0300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	04/21/2026

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