Healthcare Provider Details

I. General information

NPI: 1619119443
Provider Name (Legal Business Name): DEBBIE KAY RUTLEDGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17050 BAXTER RD SUITE 110
CHESTERFIELD MO
63005-1422
US

IV. Provider business mailing address

17050 BAXTER RD SUITE 110
CHESTERFIELD MO
63005
US

V. Phone/Fax

Practice location:
  • Phone: 636-537-0122
  • Fax: 636-537-0480
Mailing address:
  • Phone: 636-537-0122
  • Fax: 636-537-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number090136
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: