Provider Demographics
NPI:1760644108
Name:KETCHUM, JENNIFER M (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:990 ELLISTON WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-5482
Mailing Address - Country:US
Mailing Address - Phone:615-550-5221
Mailing Address - Fax:615-550-5226
Practice Address - Street 1:990 ELLISTON WAY STE 100
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-5482
Practice Address - Country:US
Practice Address - Phone:615-550-5221
Practice Address - Fax:615-550-5226
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000047365208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics