Provider Demographics
NPI:1316720782
Name:KETCHERSIDE, ALMA NAYELI
Entity type:Individual
Prefix:
First Name:ALMA
Middle Name:NAYELI
Last Name:KETCHERSIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W LAS CRUCES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1804
Mailing Address - Country:US
Mailing Address - Phone:575-522-2922
Mailing Address - Fax:
Practice Address - Street 1:210 W LAS CRUCES AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1804
Practice Address - Country:US
Practice Address - Phone:575-522-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker