Ketcham, Sedra Jo

Ketcham, Sedra Jo is an individual health care provider with primary practice located at 615 N Michigan St 1St Fl Hospitalist Ste, South Bend IN 46601-1033. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Ketcham, Sedra Jo can be contacted via phone (574) 647-3050.

Contact Information

Primary practice address
615 N Michigan St 1St Fl Hospitalist Ste South Bend IN 46601-1033
Phone: (574) 647-3050
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 71010526A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 2014013264 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 2014013264 Missouri

Profile Details

NPI number 1578803045
LBN Legal business name Ketcham, Sedra Jo
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 21st, 2013
Last updated May 1st, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578803045 NPPES
Indiana MEDICAID 300044987
Indiana MEDICAID 7100256130

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