Provider Demographics
NPI:1942739842
Name:KETCHUM, KELLY CARMELA (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:CARMELA
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2790 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-6934
Mailing Address - Country:US
Mailing Address - Phone:989-953-5320
Mailing Address - Fax:899-953-5329
Practice Address - Street 1:2790 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-6934
Practice Address - Country:US
Practice Address - Phone:989-953-5320
Practice Address - Fax:899-953-5329
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43011125192084P0800X
MI43510365142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry