Provider Demographics
NPI:1669272431
Name:KETCHEM, HENRY
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:KETCHEM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 NEW ENGLAND RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26181-9792
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:367 NEW ENGLAND RIDGE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:WV
Practice Address - Zip Code:26181-9792
Practice Address - Country:US
Practice Address - Phone:304-555-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant