Healthcare Provider Details

I. General information

NPI: 1750600870
Provider Name (Legal Business Name): WILLIAM ANDREW RUGGLES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 STATE ROUTE 3117
SOUTH SHORE KY
41175
US

IV. Provider business mailing address

137 STATE ROUTE 3117
SOUTH SHORE KY
41175-9597
US

V. Phone/Fax

Practice location:
  • Phone: 606-932-2079
  • Fax: 606-932-2313
Mailing address:
  • Phone: 606-932-2079
  • Fax: 606-932-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3273051
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3006477
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3006477
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11818
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: