Individual
SOPHIA JOSEPHINE KETCHMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
EMILE AND 42ND STREET, OMAHA, NE 68198-4440
(402) 559-4000
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2878
NE
Other
Enumeration date
10/12/2022
Last updated
02/01/2023
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