Individual
ARNOLD KETCHUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
HWY 160 & MP 394.3, KAYENTA, AZ 86033
(928) 697-4000
(928) 697-4145
Mailing address
PO BOX 368, KAYENTA, AZ 86033-0368
(928) 697-4000
(928) 697-4145
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA20030033
NM
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
67509312
—
NM
05
—
697609
—
AZ
05
—
90635256
—
CO
Enumeration date
10/26/2005
Last updated
01/04/2019
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