Individual
KIRSTEN MICAELA KETCHERSID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12895 JOSEY LN STE 114, DALLAS, TX 75234-8300
(972) 532-9967
(972) 495-2287
Mailing address
14100 SAN PEDRO AVE STE 412, SAN ANTONIO, TX 78232-2009
(210) 281-8669
(210) 314-5044
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
1019995
TX
Other
Enumeration date
03/31/2022
Last updated
03/31/2022
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