Healthcare Provider Details

I. General information

NPI: 1467441709
Provider Name (Legal Business Name): DONNA ANN KETCHESON CNP, CNM, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7155 E 38TH AVE
DENVER CO
80207-1630
US

IV. Provider business mailing address

701 SAN MATEO BLVD NE # NE7
ALBUQUERQUE NM
87108-1434
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-2458
  • Fax:
Mailing address:
  • Phone: 505-265-3511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberC-APN.0003167-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN14892
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: