Provider Demographics
NPI:1295120871
Name:KETCHUM, ASHLEY A (DO)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:A
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1890 ALABAMA HIGHWAY 157
Mailing Address - Street 2:SUITE 430
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0689
Mailing Address - Country:US
Mailing Address - Phone:256-739-1575
Mailing Address - Fax:256-517-9328
Practice Address - Street 1:1890 ALABAMA HIGHWAY 157
Practice Address - Street 2:SUITE 430
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0689
Practice Address - Country:US
Practice Address - Phone:256-739-1575
Practice Address - Fax:256-517-9328
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALDO.1820208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program