Active NPI
Beverly Karen Ketchum, CRNP
- Family Nurse Practitioner
- Huntsville, AL
National Provider Identifier
1306012133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 1-029612
- Practice address
- 1110 Meridian St N
Huntsville, AL 35801-4636 - Phone
- (256) 428-7276
- Fax
- (256) 428-7259
- NPI assigned
- May 1, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1-029612 | AL | Primary |
Addresses
Primary practice location
1110 Meridian St N
Huntsville, AL 35801-4636
Mailing address
1110 Meridian St N
Huntsville, AL 35801-4636
Phone (256) 428-7276
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-029612 | AL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heals Inc | Family | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209600000000",
"number": "1306012133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1110 MERIDIAN ST N",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358014636",
"telephone_number": "256-428-7276",
"fax_number": "256-428-7259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 MERIDIAN ST N",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358014636",
"telephone_number": "256-428-7276",
"fax_number": "256-428-7259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETCHUM",
"first_name": "BEVERLY",
"middle_name": "KAREN",
"name_prefix": "Ms.",
"credential": "CRNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-01",
"last_updated": "2008-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AL",
"license": "1-029612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntsville, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.