STACEY JO KETTLEWELL (NPI# 1164806956) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164806956 |
| Entity Type | Individual |
| Full Name | STACEY JO KETTLEWELL |
| Other Name | STACEY JO KETTLEWELL |
| Credential | PA-C |
| Practice Address |
1 Medical Park Wheeling WV 26003-6379 |
| Practice Telephone | 3042433000 |
| Practice Fax Number | 3042433060 |
| Mailing Telephone | 3042433000 |
| Mailing Fax Number | 3042433060 |
| Enumeration Date | 2015-07-12 |
| Last Update Date | 2019-10-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
1904 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
WV | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1 MEDICAL PARK |
| City | WHEELING |
| State | WV |
| Zip Code | 26003-6379 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104821305 | Wheeling Hospital Inc | General Acute Care Hospital | 1 Medical Park, Wheeling, WV 26003 | 2005-06-15 |
| 1356940548 | Kaley Anne Kuzma | Physician Assistant | 1 Medical Park, Wheeling, WV 26003-6379 | 2020-10-20 |
| 1033724240 | Kyle Louis Pytlak | Dermatology | 1 Medical Park, Wheeling, WV 26003-6379 | 2020-09-14 |
| 1932713559 | Danielle Elyse Keyser | Physical Therapist | 1 Medical Park, Wheeling, WV 26003-6300 | 2020-09-01 |
| 1063022572 | Ryan P Hunker | Physical Therapist | 1 Medical Park, Wheeling, WV 26003-6300 | 2020-08-10 |
| 1306476254 | Jacquelyn Mcclain Marshall | Nurse Practitioner | 1 Medical Park, Wheeling, WV 26003-6300 | 2020-01-20 |
| 1427696889 | Debra Jo Zeroski | Nurse Practitioner | 1 Medical Park, Wheeling, WV 26003-6300 | 2019-12-17 |
| 1912548553 | Sierra Nicole Moore | Physician Assistant | 1 Medical Park, Wheeling, WV 26003-6379 | 2019-10-04 |
| 1861048035 | Jordan Rachelle Robinson | Physician Assistant | 1 Medical Park, Wheeling, WV 26003-6300 | 2019-08-14 |
| 1659927101 | Nicole Yvonne Larue | Occupational Therapist | 1 Medical Park, Wheeling, WV 26003-6379 | 2019-08-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669070538 | Ashley Lynn Fleming | Case Manager/Care Coordinator | 442 Woodland Acres Rd, Wheeling, WV 26003 | 2020-10-13 |
| 1982202057 | Tiffany Renee Beck | Behavioral Analyst | 1007 Market Street, Wheeling, WV 26003 | 2020-10-12 |
| 1922620426 | Abbey Lynne Griffith | Speech-Language Pathologist | 199 Co Rd 7/7, Jane Lew, WV 26003 | 2020-05-07 |
| 1801309414 | Amy Wade | Counselor | 2204 Eoff Street, Wheeling, WV 26003 | 2017-11-06 |
| 1053840157 | Syl Solution Marketing | Durable Medical Equipment & Medical Supplies | 800 Hazlett Ave, Wheeling, WV 26003 | 2017-06-12 |
| 1568917334 | Hamed M Motlagh | Dentist | 53 14th St Ste 208, Wheeling, WV 26003 | 2016-08-22 |
| 1922454446 | Carrie Ann Warman | Pharmacist | 200 Mt.dechantal Road, Wheeling, WV 26003 | 2016-05-13 |
| 1447636691 | Ashley M Zando | Nurse Anesthetist, Certified Registered | 109 Mt Wood Road, Wheeling, WV 26003 | 2015-08-10 |
| 1194126441 | John Greaves | Specialist/Technologist | 135 Springdale Ave, Wheeling, WV 26003 | 2014-09-05 |
| 1154747210 | Donald Lee Rebich | Pharmacist | 61-29th Street, Wheeling, WV 26003 | 2014-03-13 |
| Find all providers in zip 26003 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205842713 | Melissa M Glauser | Physician Assistant | 1021 Mt Dechantel Road, Wheeling, WV 26003 | 2006-08-01 |
| 1255846671 | James Keith Burress Jr. | Physician Assistant | 2000 Eoff St, Wheeling, WV 26003-3823 | 2017-12-07 |
| 1952810046 | Nathan Merl Musser | Physician Assistant | 1 Medical Park, Wheeling, WV 26003-6379 | 2017-09-21 |
| 1043526692 | Brittney J Sobota | Physician Assistant | 1 Medical Park, Wheeling Hospital Inc, Wheeling, WV 26003-6379 | 2010-08-20 |
| 1295983104 | Christopher C Hill | Physician Assistant | 1 Medical Park, Wheeling Hospital Inc, Wheeling, WV 26003 | 2008-09-04 |
| 1922188622 | Scott Brandon Ramos | Physician Assistant | 2000 Eoff St, Wheeling, WV 26003-3823 | 2006-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649561408 | Trell Marie Stowell | Physician Assistant | 1 Medical Center Drive, Suite 9238, Wvu Dept. of Surgery, Morgantown, WV 26506 | 2011-04-28 |
| 1821158536 | Brook E Morgan | Physician Assistant | 1600 Murdoch Avenue, Suite 100, Parkersburg, WV 26101 | 2006-12-11 |
| 1104823830 | Michael Lee Belcher | Physician Assistant | 230 George St, Suite 2, Beckley, WV 25801-2620 | 2005-07-07 |
| 1871145623 | Anthony Paul Brunetti | Physician Assistant | 215 Brookshire Ln, Beckley, WV 25801-6729 | 2019-07-11 |
| 1346733086 | Kari Rae Hunter | Physician Assistant | 210 Brooks St Ste 200, Charleston, WV 25301-1848 | 2018-06-07 |
| 1275035685 | Holly Harris | Physician Assistant | 1 Medical Center Dr, Morgantown, WV 26506-1200 | 2018-03-01 |
| 1346751237 | Adam Nathaniel Hill | Physician Assistant | 415 Morris St Ste 400, Charleston, WV 25301-1854 | 2017-10-18 |
| 1538688650 | Nancy Balewski | Physician Assistant | 1 Medical Center Dr, Morgantown, WV 26506-1200 | 2017-09-11 |
| 1295259117 | Josee Leigh Zydonik | Physician Assistant | 1 Medical Center Dr, Morgantown, WV 26506-1200 | 2017-08-02 |
| 1043756216 | Isaac Edmonds | Physician Assistant | 1 Medical Center Dr, Morgantown, WV 26506-1200 | 2017-01-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.