Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 20442 | SC |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 20442 | SC |
N | 363LG0600X | Nurse Practitioner - Gerontology | 20442 | SC |
N | 363LP2300X | Nurse Practitioner - Primary Care | 20442 | SC |
NPI | 1033651526 |
---|---|
Provider Name | Kishimjan Beishenalievna Ketner |
First Address | Asheville, NC 28801-4160 |
Second Address | Asheville, NC 28801-4160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2016 |
Last Update Date | 15/11/2016 |