Active NPI
Kettlie Joseph
- Registered Nurse
- Queens Village, NY
National Provider Identifier
1861768434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 653078
- Practice address
- 22121 Jamaica Ave
Queens Village, NY 11428-2015 - Phone
- (718) 468-6923
- NPI assigned
- Mar 28, 2012
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 653078 | NY | Primary |
Addresses
Primary practice location
22121 Jamaica Ave
Queens Village, NY 11428-2015
Mailing address
22121 Jamaica Ave
Queens Village, NY 11428-2015
Phone (718) 468-6923
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 653078 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332892800000",
"number": "1861768434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22121 JAMAICA AVE",
"city": "QUEENS VILLAGE",
"state": "NY",
"postal_code": "114282015",
"telephone_number": "718-468-6923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22121 JAMAICA AVE",
"city": "QUEENS VILLAGE",
"state": "NY",
"postal_code": "114282015",
"telephone_number": "718-468-6923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOSEPH",
"first_name": "KETTLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-28",
"last_updated": "2012-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "653078",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Queens Village, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.