Healthcare Provider Details

I. General information

NPI: 1033956172
Provider Name (Legal Business Name): KAITLIN R RUETHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 POINT LOOKOUT RD
LEONARDTOWN MD
20650-2015
US

IV. Provider business mailing address

6232 HALYARD CT
ROCKLEDGE FL
32955-5764
US

V. Phone/Fax

Practice location:
  • Phone: 301-475-8981
  • Fax:
Mailing address:
  • Phone: 321-432-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: