Provider Demographics
NPI:1285108514
Name:KETCHAM, RAYMOND H (FNP)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:H
Last Name:KETCHAM
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 W LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3423
Mailing Address - Country:US
Mailing Address - Phone:602-824-9935
Mailing Address - Fax:
Practice Address - Street 1:7320 E DEER VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7453
Practice Address - Country:US
Practice Address - Phone:480-502-0250
Practice Address - Fax:480-596-2490
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ220932363LF0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily