Active NPI
Karen Marie Ketcham, RD, CDN, CDE
- Registered Dietitian
- Glens Falls, NY
National Provider Identifier
1619095890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 002240-1
- Practice address
- 100 Park St
Glens Falls, NY 12801-4413 - Phone
- (518) 926-2637
- Fax
- (518) 926-2091
- NPI assigned
- Mar 27, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 002240-1 | NY | Primary |
Addresses
Primary practice location
100 Park St
Glens Falls, NY 12801-4413
Mailing address
21 5TH St
Glens Falls, NY 12801-4215
Phone (518) 338-3953
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002240-1 | Other | NY | DIETETICS AND NUTRITION |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002240-1 | NY | MD | Registered Dietitian |
| 002240 | NY | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1619095890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 5TH ST",
"city": "GLENS FALLS",
"state": "NY",
"postal_code": "128014215",
"telephone_number": "518-338-3953",
"fax_number": "518-926-2091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 PARK ST",
"city": "GLENS FALLS",
"state": "NY",
"postal_code": "128014413",
"telephone_number": "518-926-2637",
"fax_number": "518-926-2091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETCHAM",
"first_name": "KAREN",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "RD, CDN, CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-27",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "002240-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIETETICS AND NUTRITION",
"identifier": "002240-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glens Falls, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.