Basic Information
| Provider Information | |||||||||
| NPI: | 1487770285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KETRING | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | HENRY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1604 WILDERNESS DR | ||||||||
| Address2: | NA | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730716100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057015084 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4400 S. LINCOLN AVENUE | ||||||||
| Address2: | PACT OFFICE | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044250449 | ||||||||
| FaxNumber: | 4054250313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | R0070739 | OK | Y | Nursing Service Providers | Registered Nurse | Case Management |
No ID Information.