Healthcare Provider Details

I. General information

NPI: 1770547697
Provider Name (Legal Business Name): AMY J. RUGGLES M.A./CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VA DR VAMC 126-LD/C&P AUDIOLOGY
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

283 BURKE RD
LEXINGTON KY
40511-2003
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax:
Mailing address:
  • Phone: 859-233-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0160
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: