Provider Demographics
NPI:1518996263
Name:KETTLESTRINGS, LISA MARIE (PA -C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:KETTLESTRINGS
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Gender:F
Credentials:PA -C
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Mailing Address - Street 1:PO BOX 5005
Mailing Address - Street 2:
Mailing Address - City:BAY PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33744-5005
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:727-319-1003
Practice Address - Street 1:10000 BAY PINES BLVD
Practice Address - Street 2:
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744-8200
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-319-1003
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-04-27
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Provider Licenses
StateLicense IDTaxonomies
FL9101628363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant