Active NPI
Jeffrey Lynde Kettelhut, BS IN PHARMACY
- Pharmacist
- Festus, MO
National Provider Identifier
1013705615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2002030459
- Practice address
- 1275 N Truman Blvd
Festus, MO 63028-1176 - Phone
- (844) 853-8937
- NPI assigned
- Apr 25, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2002030459 | MO | Primary |
Addresses
Primary practice location
1275 N Truman Blvd
Festus, MO 63028-1176
Mailing address
1800 Community
Clinton, MO 64735-8804
Phone (844) 853-8937
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002030459 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745539200000",
"number": "1013705615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 COMMUNITY",
"city": "CLINTON",
"state": "MO",
"postal_code": "647358804",
"telephone_number": "844-853-8937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1275 N TRUMAN BLVD",
"city": "FESTUS",
"state": "MO",
"postal_code": "630281176",
"telephone_number": "844-853-8937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTELHUT",
"first_name": "JEFFREY",
"middle_name": "LYNDE",
"credential": "BS IN PHARMACY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-04-25",
"last_updated": "2025-04-25",
"certification_date": "2025-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2002030459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Festus, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.