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JENNIFER ANNE TENORIO KETCHAM CRNA
NPI 1073979746
Nurse Anesthetist, Certified Registered in Atlanta, GA

Active since January 11, 2016
1405 CLIFTON RD NE FL 3, ATLANTA, GA 30322(404) 785-6670(404) 785-1362 Get Directions Write a Review

NPPES record last updated: June 6, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 6, 2022, Jun 25, 2021, Jan 17, 2019 and 1 more (4 updates tracked since 2016).

About Jennifer Anne Tenorio Ketcham Crna NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JENNIFER ANNE TENORIO KETCHAM CRNA (NPI 1073979746) is an individual nurse anesthetist, certified registered in Atlanta, Georgia, licensed in Georgia (RN177251) and active in the NPI registry since January 2016.

NPPES Registry Identity

NPI1073979746
Entity TypeIndividualFemale
Primary Taxonomy367500000X
Provider Legal NameJENNIFER ANNE TENORIO KETCHAMCredential: CRNA
Location Address1405 CLIFTON RD NE FL 3Atlanta, GA 30322-1060
Mailing Address1405 Clifton Rd Ne Fl 3Atlanta, GA 30322-1060 · (404) 785-6670 · Fax (404) 785-1362
Phone(404) 785-6670
Fax(404) 785-1362
Sole ProprietorNo
Enumeration DateJanuary 11, 2016
Last NPPES UpdateJune 6, 20224 updates tracked since enumeration
✔ NPI 1073979746 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
License✔ Licensed in GA · RN177251
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
1405 CLIFTON RD NE FL 3, Atlanta, GA 30322
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jennifer Anne Tenorio Ketcham Crna is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Jennifer Ketcham reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Choa Hospital Based, LLC
2.9 mi
Pediatrics
1575 NORTHEAST EXPY NE
Brookhaven, GA 30329
  • Reassigned Medicare billing, Georgia enrollment
  • 251 clinicians in this Medicare group
NPI 1457695488 (404) 785-6000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MATTHEW LEWIS PAA
Anesthesiologist Assistant
1405 CLIFTON RD NE FL 3
ATLANTA, GA 30322
Dekalb County (404) 785-6670
JENNIE NAHODYL PAA
Anesthesiologist Assistant
1405 CLIFTON RD NE FL 3
ATLANTA, GA 30322
Dekalb County (404) 785-6670
JESSE FARRIS PAA
Anesthesiologist Assistant
1405 CLIFTON RD NE FL 3
ATLANTA, GA 30322
Dekalb County (404) 785-6670
KINGSLEY DUNWOODY PAA
Anesthesiologist Assistant
1405 CLIFTON RD NE FL 3
ATLANTA, GA 30322
Dekalb County (404) 785-6670
LAUREN KEISTER PAA
Anesthesiologist Assistant
1405 CLIFTON RD NE FL 3
ATLANTA, GA 30322
Dekalb County (404) 785-6670
SHIVANI MUKKAMALA MD
Anesthesiology
1405 CLIFTON RD NE FL 3
ATLANTA, GA 30322
Dekalb County (404) 785-6670
VICTORIA FERNANDEZ PAA
Anesthesiologist Assistant
1405 CLIFTON RD NE FL 3
ATLANTA, GA 30322
Dekalb County (404) 785-6670
STEVEN LIN PAA
Anesthesiologist Assistant
1405 CLIFTON RD NE FL 3
ATLANTA, GA 30322
Dekalb County (404) 785-6670

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jennifer Ketcham's NPI number?

The NPI number for Jennifer Ketcham is 1073979746. It was assigned to this individual provider in the NPPES registry on January 11, 2016.

Where is Jennifer Ketcham located?

Jennifer Ketcham practices at 1405 Clifton Rd NE Fl 3, Atlanta, GA 30322. The listed phone number is (404) 785-6670.

What is Jennifer Ketcham's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Jennifer Ketcham enrolled in Medicare?

Yes. Jennifer Ketcham is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jennifer Ketcham's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jennifer Ketcham reassigns Medicare benefits to Choa Hospital Based, LLC (Brookhaven, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jennifer Ketcham's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jennifer Ketcham was last updated on June 6, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.