Healthcare Provider Details

I. General information

NPI: 1588666143
Provider Name (Legal Business Name): BRENDA G. KETCHER M.D.,P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SAWTOOTH OAK ST
HOT SPRINGS AR
71901-7160
US

IV. Provider business mailing address

124 SAWTOOTH OAK ST
HOT SPRINGS AR
71901-7160
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-7800
  • Fax: 501-623-7866
Mailing address:
  • Phone: 501-623-7800
  • Fax: 501-623-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC8125
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: