Debra L Ketterhagen, APNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2160-033 Issued in WI

Practice address

725 American Ave
Prohealth Care Medical Associates, Inc.
Waukesha, WI 53188-5031

Phone

(262) 928-3500

Fax

(262) 544-0382

NPI assigned

Aug 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

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.

• Prohealth Medical Group Inc

  • Family Medicine Physician
  • Waukesha, WI
  • NPI 1790720613
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320796800000",
    "number": "1427064948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N17W24100 RIVERWOOD DR",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES, INC.",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881177",
            "telephone_number": "262-928-4100",
            "fax_number": "262-928-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 AMERICAN AVE",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES, INC.",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885031",
            "telephone_number": "262-928-3500",
            "fax_number": "262-544-0382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERHAGEN",
        "first_name": "DEBRA",
        "middle_name": "L",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2011-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "2160-033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36011100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Anne Kern, PHD, ACSM-CEP
• Martin William Kern, MD
• Emily M Kerr
• Madeline Kessler, PA-C
• Lindsey Ketelhut, PT, DPT
• Kettle Moraine Ambulance, LLC
• Kettle Moraine Emergency Medical Services Inc (Kettle Moraine Ambulance)
• John Thomas Kettler, CSAC, LPC-IT
• Diane Keyes, APNP, RN
• Keystone Waukesha LLC

• Nurse Practitioner in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; 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.