Provider Demographics
NPI:1295117505
Name:KETCHUM, ANNA MARIE (RNP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIE
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:971 LAKELAND DRIVE
Mailing Address - Street 2:STE 1052
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-981-9503
Mailing Address - Fax:601-981-7895
Practice Address - Street 1:971 LAKELAND DRIVE
Practice Address - Street 2:STE 1052
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-981-9503
Practice Address - Fax:601-981-7895
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR883090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily