LEAH KETCHUM (NP) – Family Nurse Practitioner, NPI 1780141044

Family Nurse Practitioner

LEAH KETCHUM (NP) is a healthcare provider. based in Yazoo city, Mississippi. specializing in Family Nurse Practitioner. They hold the professional credentials NP. They hold a License No. 903189 (MS). The NPI Number for LEAH KETCHUM (NP) is 1780141044

Main info

Female

Sole Proprietor

8 Years Of Experience

Accepts Medicare Assignment

Name

LEAH KETCHUM (NP)

NPI

1780141044

Phone

(662) 746-2261

Address

823 GRAND AVE

Enumeration Date

22 February 2019

Last Update Date

16 April 2024

Doctor Profile

Medical School Name

OTHER

Secondary Phone

6627462261

Graduation Year

2018 (8 years ago)

PAC ID

3072856236

Group Practice PAC ID

0749511574

Professional Enrollment ID

I20190510001451

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience43

Completeness75

Years active:7State licenses:1Digital endpointsOther names

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Provider Addresses for LEAH KETCHUM (NP)

Baptist Medical Center Yazoo, 823, Grand Avenue, Yazoo City, Yazoo County, Mississippi, 39194, United States
YAZOO CITY, MS 391943233
Phone: (662) 746-2261
Type: Location
823 Grand Ave
Yazoo City, MS 391943233
Phone: (662) 746-2261
Type: Location
Corporate Boulevard, Lafayette, Lafayette Parish, Louisiana, 70502, United States
LAFAYETTE, LA 705083870
Phone: (800) 893-9698
Type: Mailing
317 HIGHWAY 13 S
MORTON, MS 391173353
Phone: (601) 732-6301
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2019-05-10

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

Medicare enrolled
On CMS revalidation list
Due date assigned
Revalidate in PECOS

CMS enrollment records

Enrollment ID	Type	Specialty	State	Due date
I20190510001451	I	Nurse Practitioner	MS	TBD

What to do next

No action required while the due date shows TBD.
Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 39194)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 0749511574View full group profile

Name	Specialty	State
FARHAN NAFIS (MD)	Internal Medicine	MS
DR. WILLIAM E JR. JOHNSTON (MD)	Family Practice	MS
JAMES W JR. JOHNSON (M.D.)	-	TN
RICHARD JOHN MILES (DO)	Emergency Medicine	MS
DR. WILLIAM BRYANT WALKER (MD)	Plastic And Reconstructive Surgery, General Surgery	MS
BRUCE SABATINO (MD)	-	GA
CYNEICEYA ANNETTE WALLACE (MSN, APRN, AGPCNP-BC)	Nurse Practitioner	MS