NPI Registry.org

Susan Marie Ketchem

NPI Registration Record

Provider / OrganizationNPIDate Certified
SUSAN MARIE KETCHEM18412769462023-01-21

Susan M Ketchem PA [F] graduated in 1999 and primarily specializes in Physician Assistant.

Susan Marie Ketchem is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1841276946. Registration indicates Susan Marie Ketchem is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant: Medical, ) (All Other Specialties & Provider Types, ) (Physician Assistant Medical, Physician Assistants & Advanced Practice Nursing Providers) (Physician Assistant, )

PECOS ID2264538172
RegistrationPART-B:Y
DME:Y
HHA:Y
PMD:Y
Entity TypeIndividual
Provider NameMrs. Susan Marie Ketchem PA-C
Practice Office Address116 MCCLELLAN RD
PHILIPPI, WV US
Practice Office Telephone3044572800
Practice Office Fax3044574011
Mailing Address116 MCCLELLAN RD
PHILIPPI, WV 264168076 US
Business Telephone3044572800
Business Fax3044574011
HPT Codes
CodePractice
License No
State
363AM0700X PRIMARYAccess to Adult/Geriatric Primary Care Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician AssistantAccess to Pediatric Primary Care Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Physician Assistant: Medical

All Other Specialties & Provider Types

Physician Assistant Medical
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistant
01397
WV
OPI Codes
MK0702248 OTHER WV DEA
1841276946 OTHER WV MT STATE BC/BS
WV01397 OTHER WV THE HEALTH PLAN
3810000464 MEDICAID WV
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