LIA R KETTENIS (NPI# 1346459146) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346459146 |
| Entity Type | Individual |
| Full Name | LIA R KETTENIS |
| Credential | M.D. |
| Practice Address |
550 S Adams St Bloomington IN 47403-2165 |
| Practice Telephone | 8123336324 |
| Practice Fax Number | 8123316700 |
| Mailing Telephone | 8123336324 |
| Mailing Fax Number | 8123316700 |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-09-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
01063824A | IN | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
01063824A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200871370A | 05 |
| Street Address |
550 S ADAMS ST |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47403-2165 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023094174 | Bethany Ann Murray | Registered Nurse | 550 S Adams St, Bloomington, IN 47403-2165 | 2005-12-21 |
| 1376176065 | Laura Reece | Counselor | 550 S Adams St, Bloomington, IN 47403-2165 | 2020-02-20 |
| 1518423649 | Sierra L Hofmann | Marriage & Family Therapist | 550 S Adams St, Bloomington, IN 47403-2165 | 2019-02-13 |
| 1730659301 | Grant Thomas Gilliam | Counselor | 550 S Adams St, Bloomington, IN 47403-2165 | 2018-11-27 |
| 1275001554 | Leah D Walden | Social Worker | 550 S Adams St, Bloomington, IN 47403-2165 | 2018-11-05 |
| 1710479753 | Kevin Nelson Moore | Nurse Practitioner | 550 S Adams St, Bloomington, IN 47403 | 2018-06-05 |
| 1023536216 | Quillian Murphy | Counselor | 550 S Adams St, Bloomington, IN 47403 | 2017-09-07 |
| 1902334659 | Jessica L Cielo | Registered Nurse | 550 S Adams St, Bloomington, IN 47403 | 2017-05-25 |
| 1609225085 | Julie Miller | Social Worker | 550 S Adams St, Bloomington, IN 47403-2165 | 2016-06-07 |
| 1023494333 | Nandita Miriam Rajanayakam | Counselor | 550 S Adams St, Bloomington, IN 47403-2165 | 2015-08-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043783673 | Brook Whitaker | Registered Nurse | 4011 S. Monroe Medical Park Blvd, Bloomington, IN 47403 | 2019-01-07 |
| 1598251175 | Jacob Edward Lundorf | Nurse Practitioner | 2100 S Liberty Dr Ste B, Bloomington, IN 47403 | 2018-07-06 |
| 1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
| 1295276160 | Indiana Center for Recovery, LLC | Substance Abuse Rehabilitation Facility | 1004 W 1st Street, Bloomington, IN 47403 | 2017-03-13 |
| 1144694217 | Kayla Dewolf | Specialist/Technologist | 1471 W Allen St, Bloomington, IN 47403 | 2015-11-30 |
| 1164806444 | Monroe Hosoital | General Acute Care Hospital | 4011 Monroe Medical Park, Bloomington, IN 47403 | 2015-07-16 |
| 1821411588 | Jennifer Turner | Occupational Therapy Assistant | 1023 West Main St, Swiss Villa, Vevay, IN 47403 | 2014-01-30 |
| 1104170232 | Kendall Basore | Social Worker | 445 S. Landmark Ave., Bloomington, IN 47403 | 2012-10-26 |
| 1568715886 | Indiana Hearing LLC | Hearing Aid Equipment | 2019 S Liberty Dr, Bloomington, IN 47403 | 2012-10-24 |
| 1679870232 | Accurate Hearing Services | Clinic/Center | 1355 W Second St, #3, Bloomington, IN 47403 | 2011-02-17 |
| Find all providers in zip 47403 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922212638 | Rhoda Jean Gottfried | Psychiatry & Neurology | 3024 E Empire St, 2nd Floor Suite A, Bloomington, IL 61704-5402 | 2007-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659695278 | Harmony Medical Associates LLC | Psychiatry & Neurology | 11837 Wedgeport Ln, Fishers, IN 46037-7987 | 2010-03-25 |
| 1508046624 | Kearn D Hinchman D O Inc | Psychiatry & Neurology | 53779 Generations Dr Ste 1, South Bend, IN 46635-1576 | 2007-11-06 |
| 1144337791 | Benjamin Louis Troy | Psychiatry & Neurology | 230 East Day Road, Suite 160, Mishawaka, IN 46545-3463 | 2006-08-23 |
| 1770526618 | Elizabeth A Taylor | Psychiatry & Neurology | 3055 N Lake Ct, Newburgh, IN 47630 | 2006-06-14 |
| 1407807746 | Syed J Khan | Psychiatry & Neurology | 10765 Lantern Road, Suite 102, Fishers, IN 46038-3597 | 2006-05-12 |
| 1821060294 | Michael Welling | Psychiatry & Neurology | 2040 Shadeland Ave, Ste 200, Indianapolis, IN 46219-1734 | 2006-02-01 |
| 1184616294 | Fadia T Aldahan | Psychiatry & Neurology | 5502 East 16th Street, Suite A21, Indianapolis, IN 46218-4932 | 2005-08-16 |
| 1700337920 | Kledzik Psychiatric LLC | Psychiatry & Neurology | 9245 N Meridian St, 225, Indianapolis, IN 46260-1836 | 2016-10-24 |
| 1255714390 | Ahmed Montaser | Psychiatry & Neurology | 121 Buntin St, Vincennes, IN 47591-1320 | 2015-07-07 |
| 1215334008 | Mind Md LLC | Psychiatry & Neurology | 833 Park East Blvd, Lafayette, IN 47905-0785 | 2014-11-24 |
| Find all providers with the same taxonomy | ||||
| City | BLOOMINGTON |
| Zip Code | 47403 |
Please comment or provide details below to improve the information on LIA R KETTENIS.
| 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.