Active NPI
Debra Lynn Kettleson, APRN
- Nurse Practitioner
- Hilo, HI
National Provider Identifier
1467536680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- APRN566
- Practice address
- 80 Pauahi St
Hilo, HI 96720-3065 - Phone
- (808) 935-5018
- Fax
- (808) 935-5018
- NPI assigned
- Oct 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APRN566 | HI | Primary |
Addresses
Primary practice location
80 Pauahi St
Hilo, HI 96720-3065
Mailing address
670 Ponahawai St
Ste 221
Hilo, HI 96720-7829
Phone (808) 935-5018
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN566 | HI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morris Mitsunaga, M.D., Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
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- Honolulu, HI
- NPI 1336413913
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470355200000",
"number": "1467536680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 PONAHAWAI ST",
"address_2": "STE 221",
"city": "HILO",
"state": "HI",
"postal_code": "967207829",
"telephone_number": "808-935-5018",
"fax_number": "808-935-5018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 PAUAHI ST",
"city": "HILO",
"state": "HI",
"postal_code": "967203065",
"telephone_number": "808-935-5018",
"fax_number": "808-935-5018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTLESON",
"first_name": "DEBRA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-24",
"last_updated": "2016-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "HI",
"license": "APRN566",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hilo, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.