Stacey Jo Kettlewell, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

1904 Issued in WV

Practice address

1 Medical Park
Wheeling, WV 26003-6379

Phone

(304) 243-3000

Fax

(304) 243-3060

NPI assigned

Jul 12, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Stacey Jo Kettlewell Former name

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Wheeling Hospital Inc

  • Family Medicine Physician
  • Wheeling, WV
  • NPI 1548923923
  Medicare reassignment NPD
• Wheeling Hospital, Inc.

  • Anesthesiology Physician
  • Wheeling, WV
  • NPI 1922282581
  NPD (past)

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

{
    "created_epoch": "1436659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571356800000",
    "number": "1164806956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036379",
            "telephone_number": "304-243-3000",
            "fax_number": "304-243-3060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036379",
            "telephone_number": "304-243-3000",
            "fax_number": "304-243-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTLEWELL",
        "first_name": "STACEY",
        "middle_name": "JO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-12",
        "last_updated": "2019-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WV",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WV",
            "license": "1904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "KETTLEWELL",
            "middle_name": "JO",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carter A Kenamond, M.D.
• Mark C Kenamond, MD
• Thomas G Kenamond, M.D.
• Terry R Kennon, R.PH.
• Alex Kernan-Davis
• Danielle Elyse Keyser, DPT
• Busaina L Khalil, M.D.
• Aamir Khan, DPM
• Anam N Khan, MD
• Misha Khalid Khan, MBBS/MD

• Surgical Physician Assistant in Wheeling, WV
• Providers in Wheeling, WV by specialty
• Surgical Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.