Individual
BEVERLY E KETCHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
26 CITY HALL MALL, MEDFORD, MA 02155-4754
(781) 306-5100
Mailing address
26 CITY HALL MALL, MEDFORD, MA 02155-4754
(781) 306-5100
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
110231
MA
363LF0000X
Family Nurse Practitioner
110231
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0359980
—
MA
01
—
N409
HARVARD PILGRIM
MA
01
—
NP1624
BLUE CROSS
MA
Enumeration date
03/21/2006
Last updated
01/05/2021
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