Active NPI
Kimberly Marie Ketchum, ASW
- Social Worker
- Escondido, CA
National Provider Identifier
1912514480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 98320
- Practice address
- 1341 N Escondido Blvd
Escondido, CA 92026-2507 - Phone
- (760) 214-4304
- NPI assigned
- Sep 28, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 98320 | CA | Primary |
| Counselor | 101Y00000X |
Addresses
Primary practice location
1341 N Escondido Blvd
Escondido, CA 92026-2507
Mailing address
1341 N Escondido Blvd
Escondido, CA 92026-2507
Phone (760) 214-4304
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 |
|---|---|---|---|
| 98320 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629936000000",
"number": "1912514480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1341 N ESCONDIDO BLVD",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920262507",
"telephone_number": "760-214-4304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1341 N ESCONDIDO BLVD",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920262507",
"telephone_number": "760-214-4304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETCHUM",
"first_name": "KIMBERLY",
"middle_name": "MARIE",
"credential": "ASW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-28",
"last_updated": "2021-08-26",
"certification_date": "2021-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "98320",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Escondido, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.