Provider Demographics
NPI:1215955273
Name:KETCHUM, MEG (NP)
Entity type:Individual
Prefix:MS
First Name:MEG
Middle Name:
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:117 WEST BUNNY AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-434-5497
Mailing Address - Fax:805-434-0917
Practice Address - Street 1:350 POSADA LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4060
Practice Address - Country:US
Practice Address - Phone:805-434-5497
Practice Address - Fax:805-434-0917
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA13842363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health