Kettly House LLC

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

Legal business name

KETTLY HOUSE LLC

Practice address

2191 NW 74TH Ave
Sunrise, FL 33313-3855

Phone

(954) 546-0667

NPI assigned

Sep 4, 2025

Organization subpart

No

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

Authorized official

Name

Kettly Derival, RNNPI 1497903306

Title

Ceo

Phone

(954) 546-0667

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kettly Derival, RN

  • Registered Nurse
  • North Baldwin, NY
  • NPI 1497903306
  NPD Authorized official

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

{
    "created_epoch": "1756944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1457231003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2191 NW 74TH AVE",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333133855",
            "telephone_number": "954-546-0667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2191 NW 74TH AVE",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333133855",
            "telephone_number": "954-546-0667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETTLY HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-04",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A",
        "authorized_official_last_name": "DERIVAL",
        "authorized_official_first_name": "KETTLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-546-0667",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allyson Kayton, RMHI, DNP, MSN, NNP
• Namirembe Joan Kazibwe, MD
• Precious Kelly
• Victoria Kelly
• Anthony S. Kerns, CRNA
• Key Behavior Therapy, LLC
• Shubham Khajanchi
• Claudia Patricia Khan, FNP
• Faiza Mumtaz Khan, SLP
• Saba Naz Khan, M.S., CCC-SLP

• Community Health Registered Nurse in Sunrise, FL
• Providers in Sunrise, FL by specialty
• Community Health Registered Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; 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.