Provider Demographics
NPI:1255077913
Name:KETTERING, TAYLOR LAYNE (APRN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LAYNE
Last Name:KETTERING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LAYNE
Other - Last Name:LEBOEUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:100 LILLIAN GISH BLVD SW STE 201
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-6500
Mailing Address - Country:US
Mailing Address - Phone:330-809-0460
Mailing Address - Fax:
Practice Address - Street 1:100 LILLIAN GISH BLVD SW STE 201
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-6500
Practice Address - Country:US
Practice Address - Phone:330-809-0460
Practice Address - Fax:330-809-0560
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0030808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily