Provider Demographics
NPI:1508495706
Name:GUILLITE, KETTIA NEPHTALIE
Entity type:Individual
Prefix:
First Name:KETTIA
Middle Name:NEPHTALIE
Last Name:GUILLITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5619
Mailing Address - Country:US
Mailing Address - Phone:505-278-8575
Mailing Address - Fax:
Practice Address - Street 1:301 S LAKE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5619
Practice Address - Country:US
Practice Address - Phone:505-278-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2025-0787207RN0300X
NY323904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine