Individual
MRS. SUSAN MARIE KETCHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
116 MCCLELLAN RD, PHILIPPI, WV 26416-8076
(304) 457-2800
(304) 457-4011
Mailing address
116 MCCLELLAN RD, PHILIPPI, WV 26416-8076
(304) 457-2800
(304) 457-4011
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01397
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841276946
MT STATE BC/BS
WV
05
—
3810000464
—
WV
01
—
WV01397
THE HEALTH PLAN
WV
Enumeration date
12/20/2005
Last updated
03/07/2023
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