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NPI Code Detail

MEDICARE: SIDNEY NICOLE KETCHERSIDE

MEDICARE: SIDNEY NICOLE KETCHERSIDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1023950292
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIDNEY NICOLE KETCHERSIDE
Provider Business Mailing Address
First Line : 1075 CREEKSIDE RIDGE DR STE 280
Second Line :
City : ROSEVILLE
State : CA
Zip : 95678-3504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2291 W MARCH LN STE C101
Second Line :
City : STOCKTON
State : CA
Zip : 95207-6669
Country : US
Telephone Number : 916-729-3098
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

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Directions to “ SIDNEY NICOLE KETCHERSIDE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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