Doctor Name: | MRS. ANNE MONTGOMERY KETCHAM |
NPI Number: | 1093189276 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 1-127785 |
Business Practice Address: | 504 Brookwood Blvd Homewood, AL - 352096802 |
Business Phone Number: | 3344622241 |
Business Fax Number: | |
Mailing Address: | 504 Brookwood Blvd, BIRMINGHAM |
State: | AL |
Postal Code: | 352096802 |
Phone Number: | 2058719661 |
Fax Number: | 2058701621 |
NPI Enumeration Date: | 11/25/2015 |
NPI Last Update Date: | 02/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1-127785 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |