NPIMap

Organization Active NPI

Carolyn N. Ketchel, P.a.

  • Clinical Social Worker
  • Mary Esther, FL
National Provider Identifier
1275877086
Registry record updated Feb 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW4709 Issued in FL
Legal business name
CAROLYN N. KETCHEL, P.A.
Practice address
151 Mary Esther Blvd
Suite 302
Mary Esther, FL 32569-1973
Phone
(850) 243-1302
Fax
(850) 301-0671
NPI assigned
Nov 16, 2012
Last updated
Feb 12, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2014

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

Authorized official

Name
Carolyn N. Ketchel, LCSWNPI 1972872216
Title
President
Phone
(850) 243-1302

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW4709 FL Primary

Addresses

Primary practice location

151 Mary Esther Blvd
Suite 302
Mary Esther, FL 32569-1973

Mailing address

PO Box 7
Shalimar, FL 32579-0007
Phone (850) 243-1302

National Provider Directory

National Provider Directory

Locations

68 Beal Pkwy NW
Fort Walton Beach, FL 32548
Phone (850) 243-7035

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392163200000",
    "number": "1275877086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7",
            "city": "SHALIMAR",
            "state": "FL",
            "postal_code": "325790007",
            "telephone_number": "850-243-1302",
            "fax_number": "850-301-0671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 MARY ESTHER BLVD",
            "address_2": "SUITE 302",
            "city": "MARY ESTHER",
            "state": "FL",
            "postal_code": "325691973",
            "telephone_number": "850-243-1302",
            "fax_number": "850-301-0671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLYN N. KETCHEL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-16",
        "last_updated": "2014-02-12",
        "status": "A",
        "authorized_official_last_name": "KETCHEL",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-243-1302",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW4709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mary Esther, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.