MS. NICOLETTE MCDERMOTT-KETCHUM (NPI# 1417947813) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417947813 |
| Entity Type | Individual |
| Full Name | MS. NICOLETTE MCDERMOTT-KETCHUM |
| Credential | PAC |
| Practice Address |
Hwy 160 & Mp 394.3 Kayenta AZ 86033 |
| Mailing Address |
Po Box 368 Kayenta AZ 86033-0368 |
| Practice Telephone | 9286974000 |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2019-01-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA20030034 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 40907503 | 05 | |
| CO | 61276031 | 05 | |
| AZ | 803727 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| Us Hwy 491 North, Shiprock, NM 87420 | 5053686401 | 5053686431 |
| Street Address |
HWY 160 & MP 394.3 |
| City | KAYENTA |
| State | AZ |
| Zip Code | 86033 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881684272 | Arnold Ketchum | Physician Assistant | Hwy 160 & Mp 394.3, Kayenta, AZ 86033 | 2005-10-26 |
| 1528238987 | Richard John Donlick Jr. | Internal Medicine | Hwy 160 & Mp 394.3, Kayenta, AZ 86033 | 2008-03-01 |
| 1639350648 | Ksenija Topic | Podiatrist | Hwy 160 & Mp 394.3, Kayenta, AZ 86033 | 2007-11-19 |
| 1427159474 | Herman Jackson Campbell | Dentist | Hwy 160 & Mp 394.3, Kayenta, AZ 86033 | 2006-09-25 |
| 1528072444 | Jose Feliu Sabatino | Dentist | Hwy 160 & Mp 394.3, Kayenta, AZ 86033 | 2006-07-28 |
| 1801836515 | Craig S Bruce | Dentist | Hwy 160 & Mp 394.3, Kayenta, AZ 86033 | 2006-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962048306 | Pauletta A Butterfly | Social Worker | Hwy. 160 Mp 394.3, Kayenta, AZ 86033 | 2019-11-20 |
| 1871143255 | Andrea Dawn Begay | Nurse's Aide | Us Hwy 160 M.p. 394.3, Kayenta, AZ 86033 | 2019-09-17 |
| 1083264451 | Mavis Ann Bahe | Nurse's Aide | Kayenta Health Center, Us Hwy 160, Mp 394.3, Kayenta, AZ 86033 | 2019-09-17 |
| 1609420165 | Emily Ingram Nimon | Registered Nurse | Kayenta Health Center Hwy 160 M.p. 394.3, Kayenta, AZ 86033 | 2019-08-01 |
| 1700439577 | Sherri A Verdon | Registered Nurse | Hwy 160 M.p 394.3, Kayenta, AZ 86033 | 2019-07-22 |
| 1447712104 | Cynthia Kaye Robbins | Registered Nurse | Us Highway 160 Mile Post 394.3, Kayenta, AZ 86033 | 2019-04-02 |
| 1871051052 | Brian Jason Miller | Registered Nurse | Hwy 160, Mile Post 394.3, Kayenta, AZ 86033 | 2019-03-07 |
| 1265915615 | Marissa Brooke Wall | Optometrist | 394.3 Us-160, Kayenta, AZ 86033 | 2018-09-12 |
| 1467952762 | Michael Ruddy | Pharmacist | Hwy 160 1/2 Mile South of Mile Post 394.3, Kayenta, AZ 86033 | 2018-02-14 |
| 1922516319 | Xavier Kelton Nelson | Spec/Tech, Pathology | Highway 160 Mp 394.3, Kayenta Health Center, Kayenta, AZ 86033 | 2018-01-19 |
| Find all providers in zip 86033 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003055815 | Derek Ringers | Physician Assistant | Highway 160 To Route 59, Chilchinbeto Clinic, Kayenta, AZ 86033 | 2009-02-18 |
| 1881684272 | Arnold Ketchum | Physician Assistant | Hwy 160 & Mp 394.3, Kayenta, AZ 86033 | 2005-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407456585 | Chelsea Lee Townsend | Physician Assistant | 6823 S 9th Ave, Phoenix, AZ 85041-6752 | 2020-10-28 |
| 1780283580 | Daryl Howden | Physician Assistant | 800 E Curry Rd Apt 3019, Tempe, AZ 85281-7057 | 2020-10-22 |
| 1669079109 | Elizabeth Yushuva Rpac, Pllc | Physician Assistant | 23220 N 71st Dr, Glendale, AZ 85310-5872 | 2020-10-07 |
| 1972100949 | Amanda Alcantar | Physician Assistant | 8822 W Minnezona Ave, Phoenix, AZ 85037-1499 | 2020-10-02 |
| 1700483898 | Athena Marie Arbuckle | Physician Assistant | 3815 E Bell Rd Ste 3600, Phoenix, AZ 85032-2166 | 2020-10-02 |
| 1033725437 | Kayla Gutierrez | Physician Assistant | 4820 W Mcrae Way, Glendale, AZ 85308-4821 | 2020-09-21 |
| 1356957062 | Kylee Ann Lattomus | Physician Assistant | 26008 N 47th Dr, Phoenix, AZ 85083-1681 | 2020-09-17 |
| 1275148280 | Patricia Miriam Rus | Physician Assistant | 23615 N 105th Dr, Peoria, AZ 85383-1195 | 2020-09-15 |
| 1457966640 | Stephanie Alonso | Physician Assistant | 7725 N Sun Flair Dr, Tucson, AZ 85741-1582 | 2020-09-14 |
| 1043825367 | Lauren Elizabeth Fraijo | Physician Assistant | 13575 W Indian School Rd Ste 700, Litchfield Park, AZ 85340-4905 | 2020-09-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.