Provider Demographics
NPI:1932199221
Name:KETCHLEY, SYLVIA M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:M
Last Name:KETCHLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1776
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98231-1776
Mailing Address - Country:US
Mailing Address - Phone:360-332-5667
Mailing Address - Fax:360-332-1776
Practice Address - Street 1:1530 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4905
Practice Address - Country:US
Practice Address - Phone:360-734-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000854363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAKET104307347OtherNATIONAL CERTIFICATION ID
WARN00054677OtherRN
WAAP30000854OtherARNP
WAAP30000854OtherARNP
WAAP30000854OtherARNP