Individual provider Active NPI

Jennifer Hope Kettler, CRNA

  • Certified Registered Nurse Anesthetist
  • Memphis, TN
National Provider Identifier
1144614058
Registry record updated Dec 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
20318 Issued in TN
Practice address
1265 Union Ave
Memphis, TN 38104-3415
Phone
(901) 725-5846
NPI assigned
Mar 28, 2015
Last updated
Dec 30, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 20318 TN Primary
Registered Nurse 163W00000X RN0000135833 TN

Addresses

Primary practice location

1265 Union Ave
Memphis, TN 38104-3415

Mailing address

6060 Primacy Pkwy
Suite 241
Memphis, TN 38119-5745
Phone (901) 725-5846

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151005003087 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9032427448 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifelinc Anesthesia VIII PLLCGroup PAC ID 3173984762, 155 clinicians

Practice addresses (Care Compare)

6242 W Andrew Johnson Hwy
Talbott, TN 37877-8604
Phone (423) 690-3274

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN0000135833TNMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Tennessee, P.C. Nurse Anesthetist, Certified Registered CurrentSince Mar 12, 2018 Accepting new patients
American Anesthesiology of Tennessee, P.C. CurrentSince Mar 12, 2018 Accepting new patients
Lifelinc Anesthesia VIII PLLC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2024 Accepting new patients
Medical Anesthesia Group, PA CurrentSince Aug 10, 2015 Accepting new patients
Lifelinc Anesthesia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2023 Accepting new patients
Lifelinc Anesthesia II, PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2023 Accepting new patients

Locations

7600 Airways Blvd
Ste D
Southaven, MS 38671
Phone (662) 349-7477

2986 Kate Bond Rd
Bartlett, TN 38133
Phone (901) 765-1000

1500 W Poplar Ave
Collierville, TN 38017
Phone (901) 227-8140

110 Hospital Dr
Jefferson Cty, TN 37760
Phone (865) 471-2431

9300 Park West Blvd
Knoxville, TN 37923
Phone (865) 427-4040

1044 Cresthaven Rd
Memphis, TN 38119
Phone (662) 470-5029

1265 Union Ave
Memphis, TN 38104
Phone (901) 516-2362

1363 S Germantown Rd
Memphis, TN 38138
Phone (901) 516-6000

1755 Kirby Pkwy
Ste 330
Memphis, TN 38120
Phone (901) 725-5846

2200 Union Ave
Memphis, TN 38104
Phone (901) 274-5813

255 S Pauline St
Memphis, TN 38104
Phone (901) 261-2804

5999 Park Ave
Memphis, TN 38119
Phone (901) 818-1080

6060 E Primacy Pkwy
Ste 241
Memphis, TN 38119
Phone (901) 725-5846

80 Humphreys Center Dr
Ste 310
Memphis, TN 38120
Phone (901) 474-3370

435 2nd St
Newport, TN 37821
Phone (423) 625-2200

100 Northcrest Dr
Springfield, TN 37172
Phone (615) 384-1531

6242 W Andrew Johnson Hwy
Talbott, TN 37877
Phone (423) 690-3250

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1427500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483056000000",
    "number": "1144614058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6060 PRIMACY PKWY",
            "address_2": "SUITE 241",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195745",
            "telephone_number": "901-725-5846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 UNION AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043415",
            "telephone_number": "901-725-5846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTLER",
        "first_name": "JENNIFER",
        "middle_name": "HOPE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-28",
        "last_updated": "2016-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "20318",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "RN0000135833",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.