Individual
ANNA KETCHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3572 DAYTON XENIA RD, SUITE 105, BEAVERCREEK, OH 45432-2886
(937) 427-4600
Mailing address
3572 DAYTON-XENIA RD., STE. 105, BEAVERCREEK, OH 45432-2838
(937) 427-4600
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
COA.17080-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000966352
ANTHEM BC/BS
OH
Enumeration date
05/04/2015
Last updated
06/08/2017
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