| Provider / Organization | NPI | Date Certified |
|---|---|---|
| SUSAN MARIE KETCHEM | 1841276946 | 2005-12-20 |
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 ID | 2264538172 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Mrs. Susan Marie Ketchem PA-C |
| Practice Office Address | 116 MCCLELLAN RD PHILIPPI, WV US |
| Practice Office Telephone | 3044572800 |
| Practice Office Fax | 3044574011 |
| Mailing Address | 116 MCCLELLAN RD PHILIPPI, WV 264168076 US |
| Business Telephone | 3044572800 |
| Business Fax | 3044574011 |
| Code | Practice | License No State |
|---|---|---|
| 363AM0700X PRIMARY | Access 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 |
| 1841276946 | OTHER | WV | MT STATE BC/BS |
| WV01397 | OTHER | WV | THE HEALTH PLAN |
| 3810000464 | MEDICAID | WV |