Healthcare Provider Details

I. General information

NPI: 1477812923
Provider Name (Legal Business Name): DAWN M KETCHUM NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N STATE ROUTE 7
PLEASANT HILL MO
64080-1426
US

IV. Provider business mailing address

PO BOX 302
PLEASANT HILL MO
64080-0302
US

V. Phone/Fax

Practice location:
  • Phone: 816-867-3095
  • Fax:
Mailing address:
  • Phone: 816-682-5856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012009899
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75650-121
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: