Healthcare Provider Details

I. General information

NPI: 1679903710
Provider Name (Legal Business Name): RUBY MCCLESKEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S 1ST ST
LOUISVILLE KY
40203-2202
US

IV. Provider business mailing address

102 OXFORD PL
LOUISVILLE KY
40207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 502-585-9444
  • Fax: 502-585-9466
Mailing address:
  • Phone: 502-609-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberKY-0388
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number3002705
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: