DR. SAMANTHA ALLEY KETRON (NPI# 1578959920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578959920 |
| Entity Type | Individual |
| Full Name | DR. SAMANTHA ALLEY KETRON |
| Credential | MD |
| Practice Address |
910 Madison Ave Suite 1031 Memphis TN 38103 |
| Mailing Address |
50 N Dunlap St Memphis TN 38103-2800 |
| Practice Telephone | 9012876756 |
| Mailing Telephone | 9012876756 |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2018-05-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 55958 | TN | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6401 Poplar Ave Ste 610, Memphis, TN 381194806 | 9017611280 | 9017619347 |
| Street Address |
910 MADISON AVE SUITE 1031 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013905165 | Isaac Fordjour | Dentist | 910 Madison Ave, Suite 710, Memphis, TN 38103-3403 | 2005-10-12 |
| 1346736857 | Hisham Neyazi Abu Farsak | Student in an Organized Health Care Education/Training Program | 910 Madison Ave, Memphis, TN 38103-3403 | 2018-07-09 |
| 1023506607 | Veronica Easton | Student in an Organized Health Care Education/Training Program | 910 Madison Ave, Memphis, TN 38103 | 2018-04-29 |
| 1386172773 | David Allen Cooper | Student in an Organized Health Care Education/Training Program | 910 Madison Ave, Memphis, TN 38103-3403 | 2017-05-30 |
| 1104352293 | University of Tennessee Health Science Center | General Acute Care Hospital | 910 Madison Ave, Ste 1031, Memphis, TN 38103-3403 | 2017-05-10 |
| 1619320868 | Muhammad Hassaan Shahid | Student in an Organized Health Care Education/Training Program | 910 Madison Ave, Memphis, TN 38103-3403 | 2016-07-22 |
| 1427403278 | Xiangxia Liu | Student in an Organized Health Care Education/Training Program | 910 Madison Ave, Suite 315, Memphis, TN 38103-3403 | 2016-04-29 |
| 1619331220 | Patrick Probst | Student in an Organized Health Care Education/Training Program | 910 Madison Ave, Suite 409, Memphis, TN 38103-3403 | 2016-04-09 |
| 1033598248 | Steven D Kozusko | Plastic Surgery | 910 Madison Ave, Memphis, TN 38103-3403 | 2015-05-20 |
| 1588042675 | Joseph Vito Russo | Student in an Organized Health Care Education/Training Program | 910 Madison Ave, Suite 1031, Memphis, TN 38103-3403 | 2015-05-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619505724 | Michelle Lynn Esposito | Dietitian, Registered | 1st Floor Research Center - 50 North Dunlap St, Memphis, TN 38103 | 2020-04-01 |
| 1962030221 | Allison Burge Clayton | Dietitian, Registered | 50 N Dunlap, Nutrition Therapy Dept, 1st Floor Research Tower, Memphis, TN 38103 | 2020-03-31 |
| 1093375420 | Radar Ems, LLC | Social Worker | 50 S. B.b. King Blvd, Suite 350, Memphis, TN 38103 | 2019-06-18 |
| 1528529021 | Denise Andrews Matthews | Nursing Care | 342 Island Dr #105, Memphis, TN 38103 | 2019-03-27 |
| 1881160059 | Christopher Paul Hernandez | Nurse Practitioner | 877 Jeffeon Ave, Memphis, TN 38103 | 2018-10-15 |
| 1194245712 | Cameron Waters Clinard | Optometrist | 127 Isle Creek Dr, Memphis, TN 38103 | 2017-06-24 |
| 1750732582 | Amanda Leigh Eaves | Nurse Practitioner | 364 S Front St Ste 201, Memphis, TN 38103 | 2016-06-22 |
| 1417304569 | John Clark Shell | Family Medicine | 150 Harbor Creek Dr, Memphis, TN 38103 | 2016-05-18 |
| 1750753695 | Tomisha V. Byard | Nurse Practitioner | 718 Habor Bend Road, Memphis, TN 38103 | 2015-10-29 |
| 1053795179 | Melissa Anne Wilkes | Social Worker | 1240 Harbor River Drive, Memphis, TN 38103 | 2015-07-18 |
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| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285015453 | Taylor Aglio | Pediatrics | 49 N Dunlap St # 131, Memphis, TN 38103-2802 | 2015-06-14 |
| 1326434465 | Amanda Green | Pediatrics | 262 N Danny Thomas Blvd # Ms 320, Memphis, TN 38105 | 2015-04-15 |
| 1366844490 | Gerard Joseph Billmeier Jr. | Pediatrics | 6465 Massey Lane, Memphis, TN 38120-3307 | 2014-09-19 |
| 1316348089 | James Levernier | Pediatrics | 4781 Park Ave, Memphis, TN 38117-5623 | 2014-09-11 |
| 1124454657 | Walter Thompson Hughes Jr. | Pediatrics | 854 River Park Dr, Memphis, TN 38103-0804 | 2013-09-16 |
| 1518301084 | Jennifer Lauren Miller | Pediatrics | 6401 Poplar Ave Ste 610, Memphis, TN 38119-4806 | 2013-04-26 |
| 1447506365 | Nickhill Hitesh Bhakta | Pediatrics | 262 Danny Thomas Way, Ms 721, Memphis, TN 38105 | 2012-07-29 |
| 1477845451 | Emilee Adelyn Dobish | Pediatrics | 850 Poplar Ave, Building 2, Memphis, TN 38103 | 2011-05-09 |
| 1366748055 | Silpa Peravali | Pediatrics | Lebonheur Childrens Hospital, 848 Adams Avenue, Memphis, TN 38103 | 2011-01-28 |
| 1275854259 | Melissa Ruth Hines | Pediatrics | 262 Danny Thomas Pl # Ms 734, Division of Pediatric Critical Care, Memphis, TN 38105-3678 | 2010-06-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.