Provider Demographics
NPI:1316128879
Name:KETTLE-CHURCH, HANNAH ELAINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:ELAINE
Last Name:KETTLE-CHURCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:ELAINE
Other - Last Name:KETTLE-CHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:221 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5066
Mailing Address - Country:US
Mailing Address - Phone:850-833-9240
Mailing Address - Fax:
Practice Address - Street 1:301 HUGHES ST NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-6403
Practice Address - Country:US
Practice Address - Phone:850-833-3355
Practice Address - Fax:850-833-3473
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5176488164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse