Healthcare Provider Details

I. General information

NPI: 1144147984
Provider Name (Legal Business Name): RYLIE M RUCKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 MAPLECREST RD
BETTENDORF IA
52722-7709
US

IV. Provider business mailing address

2535 MAPLECREST RD
BETTENDORF IA
52722-7709
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-4620
  • Fax:
Mailing address:
  • Phone: 563-421-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QD0401X
TaxonomyDiabetology (Family Medicine) Physician
License NumberA191963
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: