Healthcare Provider Details

I. General information

NPI: 1699718254
Provider Name (Legal Business Name): CINDY G RUTTAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E LAHARPE ST
KIRKSVILLE MO
63501-4520
US

IV. Provider business mailing address

900 E LAHARPE ST
KIRKSVILLE MO
63501-4520
US

V. Phone/Fax

Practice location:
  • Phone: 660-665-1962
  • Fax: 660-665-3989
Mailing address:
  • Phone: 660-665-1962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberR6N11
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberR6N11
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR6N11
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: