Carl Anderson Ketcham, DO

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1524 Pinto LN FL 2
Las Vegas, NV 89106-4195

Phone

(702) 992-6888

NPI assigned

Mar 27, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1023712874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 W WARM SPRINGS RD APT 3314",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890145517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 PINTO LN FL 2",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064195",
            "telephone_number": "702-992-6888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "118 E Haskell St",
            "address_purpose": "LOCATION",
            "city": "Winnemucca",
            "state": "NV",
            "postal_code": "894453299",
            "country_code": "US",
            "telephone_number": "775-623-5222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETCHAM",
        "first_name": "CARL",
        "middle_name": "ANDERSON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-27",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "DO4137",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tenaya Kesterson
• Christine Kestner
• Kunnara Ket, PTA
• Ketaminamd LLC
• Ketamine Wellness Centers Las Vegas
• Courtney Ketcham
• Andrea Ketchum
• David C Ketchum, D.C.
• Natalia Ketchum, RBT
• Latonya J. Ketchup, LMSW

• Student in an Organized Health Care Education/Training Program in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Student in an Organized Health Care Education/Training Program in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.