Provider Demographics
NPI:1528193455
Name:KETTLE, EMILE DELANO SR (PA)
Entity Type:Individual
Prefix:MR
First Name:EMILE
Middle Name:DELANO
Last Name:KETTLE
Suffix:SR
Gender:M
Credentials:PA
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Mailing Address - Street 1:440 RAYFORD RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4168
Mailing Address - Country:US
Mailing Address - Phone:281-419-5544
Mailing Address - Fax:281-298-3483
Practice Address - Street 1:440 RAYFORD RD
Practice Address - Street 2:SUITE 125
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4168
Practice Address - Country:US
Practice Address - Phone:281-419-5544
Practice Address - Fax:281-298-3483
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2016-10-10
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Provider Licenses
StateLicense IDTaxonomies
TXPA02461363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant