Healthcare Provider Details

I. General information

NPI: 1487284964
Provider Name (Legal Business Name): JESSICA JOANNA RUEGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST
BURNSVILLE NC
28714-2925
US

IV. Provider business mailing address

116 MCDOWELL RIDGE RD
BURNSVILLE NC
28714-4923
US

V. Phone/Fax

Practice location:
  • Phone: 828-682-1551
  • Fax: 828-675-9312
Mailing address:
  • Phone: 828-675-2767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12855
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: