MICHAEL C KETCHAM (NPI# 1912910191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912910191 |
| Entity Type | Individual |
| Full Name | MICHAEL C KETCHAM |
| Credential | DO |
| Practice Address |
4802 E Johnson Ave Jonesboro AR 72401 |
| Mailing Address |
Po Box 1960 Jonesboro AR 72403-1960 |
| Practice Telephone | 8709368000 |
| Practice Fax Number | 8709343631 |
| Mailing Telephone | 8709368000 |
| Mailing Fax Number | 8709343631 |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2018-09-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | E-10891 | AR | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 0102202980 | VA | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 222973 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
4802 E JOHNSON AVE |
| City | JONESBORO |
| State | AR |
| Zip Code | 72401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699779686 | Paul S Levy | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4802 E Johnson Ave, Jonesboro, AR 72401 | 2005-06-08 |
| 1316546138 | Emily M Allen | Nurse Practitioner | 4802 E Johnson Ave, Jonesboro, AR 72405-8413 | 2020-10-22 |
| 1699387274 | Sarah E Dulaney | Clinical Nurse Specialist | 4802 E Johnson Ave, Jonesboro, AR 72405-8413 | 2020-08-17 |
| 1154965036 | Danny Lee Ricker | Nurse Practitioner | 4802 E Johnson Ave, Jonesboro, AR 72405-8413 | 2019-11-04 |
| 1679117659 | Ryan Scott Anderson | Clinical Nurse Specialist | 4802 E Johnson Ave, Jonesboro, AR 72405-8413 | 2019-11-01 |
| 1366086787 | Jennifer L Turnbow | Nurse Practitioner | 4802 E Johnson Ave, Jonesboro, AR 72405-8413 | 2019-10-29 |
| 1487201703 | Mary Daniel Johnson | Dietitian, Registered | 4802 E Johnson Ave, Jonesboro, AR 72405-8413 | 2019-08-21 |
| 1285288357 | Kellye P Brown | Nurse Practitioner | 4802 E Johnson Ave, Jonesboro, AR 72405-8413 | 2019-07-28 |
| 1801448592 | Helen F Williams | Nurse Practitioner | 4802 E Johnson Ave, Jonesboro, AR 72405-8413 | 2019-07-12 |
| 1801350285 | Brandy N Herrington | Physician Assistant | 4802 E Johnson Ave, Jonesboro, AR 72401-8413 | 2019-01-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407453368 | Mariah Kay Jackson | Physical Therapy Assistant | Creative Kids Therapy, Jonesboro, AR 72401 | 2020-10-05 |
| 1821606005 | Kafayat Folake Iyanda | Specialist/Technologist | 2105 East Aggie Rd, Jonesboro, AR 72401 | 2020-07-14 |
| 1053936310 | Josh Roberts | Physical Therapist | 1010 South Main St, Jonesboro, AR 72401 | 2020-06-12 |
| 1003449687 | Amy Mary Elizabeth Daughhetee | Nurse Practitioner | 225 East Washington Ave, Jonesboro, AR 72401 | 2020-02-21 |
| 1871126698 | Sarah Lowtharp | Clinical Nurse Specialist | 225 East Washington Ave., Jonesboro, AR 72401 | 2020-02-20 |
| 1891335519 | Mallori Miller | Case Manager/Care Coordinator | 837 Willett Rd, Jonesboro, AR 72401 | 2020-01-10 |
| 1265073704 | Michael Bruce Collie | Registered Nurse | 837 Williett Road, Jonesboro, AR 72401 | 2019-10-07 |
| 1285283432 | Jonesboro Ambulatory Surgery Center, LLC | Clinic/Center | 1710 Mayfield Dr, Jonesboro, AR 72401 | 2019-09-10 |
| 1841843943 | Destinee Katrina Cole | Specialist/Technologist | 2015 Aggie Rd, Jonesboro, AR 72401 | 2019-07-18 |
| 1699250472 | Jessica Marie Mcnatt | Occupational Therapist | 907 County Road 753, Jonesboro, AR 72401 | 2018-09-27 |
| Find all providers in zip 72401 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396162400 | Jacqueline Conger | Obstetrics & Gynecology | 800 S Church St Ste 3, Jonesboro, AR 72401 | 2014-03-26 |
| 1073855946 | Ilana Naghi | Obstetrics & Gynecology | 800 S Church St Ste 302, Jonesboro, AR 72401-4107 | 2013-03-19 |
| 1265430581 | Carl Brady Edwards | Obstetrics & Gynecology | 800 S Church St, Suite 302, Jonesboro, AR 72401-4176 | 2005-07-11 |
| 1346248671 | Stephen Randolph Rauls | Obstetrics & Gynecology | 505 E Matthews Ave, Ste 203, Jonesboro, AR 72401-3144 | 2005-07-11 |
| 1295199099 | Kelsey Shnaekel | Obstetrics & Gynecology | 800 S Church St Ste 302, Jonesboro, AR 72401-4107 | 2016-04-07 |
| 1487074969 | Kristin E Owens | Obstetrics & Gynecology | 4802 E Johnson Ave, Jonesboro, AR 72401 | 2014-04-23 |
| 1447676937 | Christopher Bellamy | Obstetrics & Gynecology | 4802 E Johnson Ave, Jonesboro, AR 72401-8413 | 2014-03-09 |
| 1922366004 | Andrew K. Dunham | Obstetrics & Gynecology | 800 S Church St, Ste. 302, Jonesboro, AR 72401-4176 | 2012-04-26 |
| 1699086314 | Serena Nicole Vance | Obstetrics & Gynecology | 800 S Church St, Suite 302, Jonesboro, AR 72401-4176 | 2010-06-28 |
| 1265753008 | Jason Charles Coletta | Obstetrics & Gynecology | 4802 E Johnson Ave, Jonesboro, AR 72401-8413 | 2010-06-16 |
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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.