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Contact Information

NICOLETTE MCDERMOTT KETCHUM, PAC
HWY 160 & MP 394.3
KAYENTA, AZ86033
 Phone: 928-697-4000
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for NICOLETTE MCDERMOTT KETCHUM · (Female)

NPI # 1417947813
Status Active
Credentials PAC
Entity Individual
Enumeration date 10/26/2005
Last updated 01/03/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • NM License # PA20030034
  • AZ Medicaid 803727
  • CO Medicaid 61276031
  • NM Medicaid 40907503
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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