Provider Demographics
NPI:1881750115
Name:KETTMAN, JERRI LYN (RNC)
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:LYN
Last Name:KETTMAN
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BRIDGER MT ROAD SOUTH
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634
Mailing Address - Country:US
Mailing Address - Phone:406-443-0140
Mailing Address - Fax:
Practice Address - Street 1:FORT HARRISON VAMC
Practice Address - Street 2:1892 WILLIAMS STREET
Practice Address - City:FORT HARRISON
Practice Address - State:MT
Practice Address - Zip Code:59636
Practice Address - Country:US
Practice Address - Phone:406-447-7596
Practice Address - Fax:409-447-7965
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health