Individual
TIFFANY KETCHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
825 NE GATEWAY DR STE 148, GRIMES, IA 50111-1307
(515) 875-9607
(515) 875-9608
Mailing address
PO BOX 424, DES MOINES, IA 50302-0424
(515) 875-9925
(515) 875-9923
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03239
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0196063
—
IA
Enumeration date
08/11/2006
Last updated
02/20/2024
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