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MS. NICOLETTE MCDERMOTT-KETCHUM PAC
NPI 1417947813
Physician Assistant in Kayenta, AZ

Active since October 26, 2005
HWY 160 & MP 394.3, KAYENTA, AZ 86033(928) 697-4000 Get Directions Write a Review

NPPES record last updated: January 3, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Ms. Nicolette Mcdermott-ketchum Pac NPPES

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

MS. NICOLETTE MCDERMOTT-KETCHUM PAC (NPI 1417947813) is an individual physician assistant in Kayenta, Arizona, licensed in New Mexico (PA20030034) and active in the NPI registry since October 2005. She maintains a secondary practice location in Shiprock.

NPPES Registry Identity

NPI1417947813
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMS. NICOLETTE MCDERMOTT-KETCHUMCredential: PAC
Location AddressHWY 160 & MP 394.3Kayenta, AZ 86033
Mailing AddressPo Box 368Kayenta, AZ 86033-0368
Phone(928) 697-4000
Sole ProprietorNo
Enumeration DateOctober 26, 2005
Last NPPES UpdateJanuary 3, 2019
✔ NPI 1417947813 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NM · PA20030034
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
HWY 160 & MP 394.3, Kayenta, AZ 86033
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Secondary Practice Location 1

Location 1US Hwy 491 NorthShiprock, NM 87420 · Phone (505) 368-6401 · Fax (505) 368-6431

Other Identifiers 3

Medicaid40907503NM
Medicaid61276031CO
Medicaid803727AZ

Other Providers at the Same Location NPPES 5

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

JOSE FELIU SABATINO DDS
Dentist (General Practice)
HWY 160 & MP 394.3
KAYENTA, AZ 86033
Navajo County (928) 697-4000
DR. RICHARD JOHN DONLICK JR. D.O.
Internal Medicine
HWY 160 & MP 394.3
KAYENTA, AZ 86033
Navajo County (928) 697-4000
DR. KSENIJA TOPIC D.P.M.
Podiatrist
HWY 160 & MP 394.3
KAYENTA, AZ 86033
Navajo County (928) 697-4000
CRAIG S BRUCE DDS
Dentist
HWY 160 & MP 394.3
KAYENTA, AZ 86033
Navajo County (928) 697-4000
ARNOLD KETCHUM PA-C
Physician Assistant
HWY 160 & MP 394.3
KAYENTA, AZ 86033
Navajo County (928) 697-4000

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 Nicolette Mcdermott-ketchum's NPI number?

The NPI number for Nicolette Mcdermott-ketchum is 1417947813. It was assigned to this individual provider in the NPPES registry on October 26, 2005.

Where is Nicolette Mcdermott-ketchum located?

Nicolette Mcdermott-ketchum practices at Hwy 160 & Mp 394.3, Kayenta, AZ 86033. The listed phone number is (928) 697-4000.

What is Nicolette Mcdermott-ketchum's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Nicolette Mcdermott-ketchum was last updated on January 3, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.