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

Individual provider Physician Assistant · NPI 1508582446

Sophia Josephine Ketchmark, PHYSICIANASSISTANT is a Physician Assistant in Omaha, Nebraska. Qualified in 2022, 4 years ago. Practices with Unmc Physicians, a 1,484-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Nebraska.

Years since qualifying
4
Licensed in
NE
In the registry since
2022
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Practice location Address checks out

Emile And 42nd St
Omaha, NE 68198-4440
Phone: (402) 559-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1015 N 16th St Apt 217, Omaha, NE 68102-4440 — (402) 926-6229
  • 4350 Dewey Ave, Omaha, NE 68105-1017 — (402) 552-2000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2878 (NE)

Record details

NPI number1508582446
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedOctober 12, 2022
Last updated in NPPESFebruary 1, 2023
Certification dateJanuary 13, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Unmc Physicians — 1484 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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