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General NPI Number Information
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NPI Number | 1578803045
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Entity Type | Individual
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Provider Name | SEDRA JO KETCHAM APRN
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Gender | Female
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 615 N MICHIGAN ST 1ST FL HOSPITALIST STE
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City | SOUTH BEND
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State | IN
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Zip | 46601-1033
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Country | US
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Telephone | 574-647-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DRIVE SUITE 100
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City | GRANGER
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State | IN
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Zip | 46530-3245
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Country | US
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Telephone | 574-647-1840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 71010526A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2014013264
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2014013264
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License Number State | MO
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