Individual
MS. NICOLETTE MCDERMOTT-KETCHUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
HWY 160 & MP 394.3, KAYENTA, AZ 86033
(928) 697-4000
Mailing address
PO BOX 368, KAYENTA, AZ 86033-0368
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA20030034
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40907503
—
NM
05
—
61276031
—
CO
05
—
803727
—
AZ
Enumeration date
10/26/2005
Last updated
01/03/2019
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