Provider Demographics
NPI:1134924731
Name:KETTINGER, BRITTNEY BRAY (PA-C)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:BRAY
Last Name:KETTINGER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 COILE RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4103
Mailing Address - Country:US
Mailing Address - Phone:248-826-4162
Mailing Address - Fax:
Practice Address - Street 1:4021 KEITH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4341
Practice Address - Country:US
Practice Address - Phone:423-476-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant