Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Kelsey Ketchum

Individual provider Registered Nurse · NPI 1053001412

Mrs. Kelsey Ketchum is a Nurse Practitioner in Centerville, Ohio. Qualified in 2023, 3 years ago. Practices with Cg Medical Associates Inc, a 171-clinician group and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
3
Licensed in
OH
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

72 Goldengate Dr
Centerville, OH 45459-4325
Phone: (419) 605-7307
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence APRN.CNP.0033883 (OH)
Registered Nurse Taxonomy 163W00000X · Licence RN.474362 (OH)

Record details

NPI number1053001412
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMay 9, 2023
Last updated in NPPESJuly 24, 2023
Certification dateJuly 24, 2023

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Cg Medical Associates Inc — 171 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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