Individual
AVERY KETCHUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
630 N ARROWLEAF TRL, SISTERS, OR 97759-2610
(541) 549-1318
Mailing address
20086 SALLY CT UNIT 2, BEND, OR 97702-3275
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
105980
OR
Other
Enumeration date
02/24/2022
Last updated
02/24/2022
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