Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Candice Ketelsen, PA-C

Individual provider Physician Assistant · NPI 1073040515

Candice Ketelsen, PA-C is a Physician Assistant in Ridgefield, Washington. Qualified in 2017, 9 years ago. Practices with Legacy Salmon Creek Hospital, a 313-clinician group and accepts Medicare assignment. Licensed in Idaho and Washington.

Years since qualifying
9
Licensed in
ID, WA
In the registry since
2017
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

536 S Royle Rd
Ridgefield, WA 98642-7759
Phone: (360) 487-1086
Fax: (360) 487-1088
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA60758102 (WA)
Physician Assistant Taxonomy 363A00000X · Licence PA-1496 (ID)

Record details

NPI number1073040515
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 15, 2017
Last updated in NPPESJuly 14, 2026
Certification dateJuly 14, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Legacy Salmon Creek Hospital — 313 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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