Active NPI
Kelley Ketterman, BA, MED
- Addiction (Substance Use Disorder) Counselor
- Louisville, KY
National Provider Identifier
1063870434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 273669
- Practice address
- 9702 Stonestreet Rd
Louisville, KY 40272-6808 - Phone
- (833) 510-4357
- Fax
- (866) 460-2997
- NPI assigned
- Feb 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 273669 | KY | Primary |
Addresses
Primary practice location
9702 Stonestreet Rd
Louisville, KY 40272-6808
Mailing address
615 Elsinore PL Ste 200
Cincinnati, OH 45202-1457
Phone (833) 510-4357
Other practice location 1
7509 Charlestown Pike
Charlestown, IN 47111-9623
Phone (812) 256-4686 ext. 140
Other practice location 2
615 Elsinore Pl Ste 200
Cincinnati, OH 45202-1457
Phone (833) 510-4357
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 Arts, Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 273669 | KY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641945600000",
"number": "1063870434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 ELSINORE PL STE 200",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452021457",
"telephone_number": "833-510-4357",
"fax_number": "866-460-2997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9702 STONESTREET RD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402726808",
"telephone_number": "833-510-4357",
"fax_number": "866-460-2997"
}
],
"practiceLocations": [
{
"address_1": "7509 Charlestown Pike",
"address_purpose": "LOCATION",
"city": "Charlestown",
"state": "IN",
"postal_code": "471119623",
"country_code": "US",
"telephone_number": "812-256-4686 x140",
"fax_number": "812-256-4415",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "615 Elsinore Pl Ste 200",
"address_purpose": "LOCATION",
"city": "Cincinnati",
"state": "OH",
"postal_code": "452021457",
"country_code": "US",
"telephone_number": "833-510-4357",
"fax_number": "866-460-2997",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KETTERMAN",
"first_name": "KELLEY",
"name_prefix": "Ms.",
"credential": "BA, MED",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-01",
"last_updated": "2022-01-12",
"certification_date": "2022-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "KY",
"license": "273669",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.