Healthcare Provider Details

I. General information

NPI: 1619330677
Provider Name (Legal Business Name): COURTNEY LYNN KETCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 HEALTH CENTER PKWY STE 240A
YUKON OK
73099-6396
US

IV. Provider business mailing address

1205 HEALTH CENTER PKWY STE 240A
YUKON OK
73099-6396
US

V. Phone/Fax

Practice location:
  • Phone: 405-717-5496
  • Fax:
Mailing address:
  • Phone: 405-717-5496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA168350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: