Active NPI
Jamie L. Ketterman, RN, BSN, CDE
- Family Nurse Practitioner
- Clinton, MO
National Provider Identifier
1609087402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2014022528
- Practice address
- 1602 N 2ND St
Clinton, MO 64735-1192 - Phone
- (660) 885-8171
- NPI assigned
- May 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diabetes Educator Registered Nurse | 163WD0400X | 2000162289 | MO | |
| Family Nurse Practitioner | 363LF0000X | 2014022528 | MO | Primary |
Addresses
Primary practice location
1602 N 2ND St
Clinton, MO 64735-1192
Mailing address
1602 N 2ND St
Clinton, MO 64735-1192
Phone (660) 885-8171
Other practice location 1
603 E Gaines Dr
Clinton, MO 64735-3205
Phone (660) 885-8141
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 357499904 | Medicaid | MO |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jamieketterman@mhccaremail.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1602 N 2ND St
Golden Valley Medical Clinton
Clinton, MO 64735-1192
Phone (660) 890-8023
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Bachelor on Science - Nursing, Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000162289 | MO | MD | Diabetes Educator Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Golden Valley Memorial Hospital District | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Golden Valley Medical - Clinton
- Rural Health Clinic/Center
- Clinton, MO
- NPI 1003873266
-
dba Golden Valley Medical - Warsaw
- Rural Health Clinic/Center
- Warsaw, MO
- NPI 1366490971
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Clinton, MO
- NPI 1710075361
-
dba Novus Lifecare
- Home Health Agency
- Clinton, MO
- NPI 1053208892
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637020800000",
"number": "1609087402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1602 N 2ND ST",
"city": "CLINTON",
"state": "MO",
"postal_code": "647351192",
"telephone_number": "660-885-8171",
"fax_number": "660-890-8422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1602 N 2ND ST",
"city": "CLINTON",
"state": "MO",
"postal_code": "647351192",
"telephone_number": "660-885-8171"
}
],
"practiceLocations": [
{
"address_1": "603 E Gaines Dr",
"address_purpose": "LOCATION",
"city": "Clinton",
"state": "MO",
"postal_code": "647353205",
"country_code": "US",
"telephone_number": "660-885-8141",
"fax_number": "660-885-5815",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KETTERMAN",
"first_name": "JAMIE",
"middle_name": "L.",
"credential": "RN, BSN, CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2021-11-16",
"certification_date": "2021-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "163WD0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Diabetes Educator",
"state": "MO",
"license": "2000162289",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "2014022528",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "357499904",
"state": "MO"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jamieketterman@mhccaremail.com",
"affiliation": "N",
"address_1": "1602 N 2nd St",
"city": "Clinton",
"state": "MO",
"country_code": "US",
"postal_code": "647351192",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Clinton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; 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.
- 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.