Brianna Ketchem, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0005525 Issued in CO

Practice address

1120 E Elizabeth St, Building G Ste 2
Fort Collins, CO 80524-4044

Phone

(970) 493-9193

NPI assigned

Sep 19, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Brianna Babb Former name

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Well Nourished LLCGroup PAC ID 6608249669, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Physician Assistant

State licenses

Practice roles

Locations

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.

• Well Nourished LLC

  • Adult Mental Health Clinic/Center
  • Golden, CO
  • NPI 1598409468
  Medicare reassignment Care Compare group
• Rocky Mountain Clinics LLC

  • Addiction Medicine (Family Medicine) Physician
  • Fort Collins, CO
  • NPI 1295450294
  Medicare reassignment
• Rocky Mountain Clinics, LLC

  • Addiction Medicine (Family Medicine) Physician
  • Alamosa, CO
  • NPI 1285468546
  NPD
• Front Range Clinic Inc.

  • Addiction Medicine (Family Medicine) Physician
  • Aurora, CO
  • NPI 1275052722
  NPD (past)

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

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1750865424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 S HOLLAND CT",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802325133",
            "telephone_number": "814-282-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 E ELIZABETH ST, BUILDING G STE 2",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244044",
            "telephone_number": "970-493-9193"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1410 Vance St Ste 211",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CO",
            "postal_code": "802145435",
            "country_code": "US",
            "telephone_number": "720-636-6537",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1411 S Potomac St Ste 340",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800124539",
            "country_code": "US",
            "telephone_number": "814-282-0373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETCHEM",
        "first_name": "BRIANNA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-19",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "0005525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRIANNA",
            "last_name": "BABB",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicole Allison Kershner, M.D.
• Katelyn Kerstetter
• James M Kesler, M.D.
• Jessica Kessel, PT, DPT
• Kestrel Behavioral Health Consulting, LLC
• Clair L Ketchum
• Gregory Earl Ketchum
• Shanna Ketteridge, LPC, MC
• Kaitlyn Keyes Rhames, DPT
• David Keyes

• Physician Assistant in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.