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General NPI Number Information
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NPI Number | 1891995452
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Entity Type | Organization
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Legal Business Name | BRENDA KETCHER, M.D.,P.A.
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 124 SAWTOOTH OAK ST
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City | HOT SPRINGS
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State | AR
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Zip | 71901-7160
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Country | US
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Telephone | 501-623-7800
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Fax | 501-623-7866
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Provider Business Mailing Address
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Address Line | 124 SAWTOOTH OAK ST
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City | HOT SPRINGS
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State | AR
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Zip | 71901-7160
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Country | US
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Telephone | 501-623-7800
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Fax | 501-623-7866
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA KETCHER
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Credential | M.D.
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Telephone | 501-623-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | C8125
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License Number State | AR
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