Debra Kettleson Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0381075 Issued in HI

Legal business name

DEBRA KETTLESON INC

Practice address

670 Ponahawai St Ste 221
Hilo, HI 96720-7829

Phone

(808) 365-5988

Fax

(808) 365-5989

NPI assigned

Nov 12, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debra Lynn Kettleson

Title

Owner/Provider

Phone

(808) 365-5988

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420416000000",
    "number": "1134525546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 PONAHAWAI ST STE 221",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967207829",
            "telephone_number": "808-365-5988",
            "fax_number": "808-365-5989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 PONAHAWAI ST STE 221",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967207829",
            "telephone_number": "808-365-5988",
            "fax_number": "808-365-5989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEBRA KETTLESON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-12",
        "last_updated": "2015-01-05",
        "status": "A",
        "authorized_official_last_name": "KETTLESON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "808-365-5988"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "0381075",
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "HI",
            "license": "2009004214",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ty Jordan Tsuji De Silva, M.D.
• Kate Lee Esther De Soto
• Janet Lynn Deal, LMT
• Realm Deam
• Daniel A Debaca, O.D.
• Julie Ann Deguair
• Krystal Noelani Del Rosario, LCSW
• Francis D. Delacruz
• Juliana Delenia-Tabbada
• Jadee-Marie Delima

• Family Medicine Physician in Hilo, HI
• Providers in Hilo, HI by specialty
• Family Medicine Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.