Healthcare Provider Details

I. General information

NPI: 1659602928
Provider Name (Legal Business Name): KATHERINE RUTHSATZ KJERGAARD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 EAST COLLEGE STREET
SHELBY NC
28152
US

IV. Provider business mailing address

201 DANTE LN
SIMPSONVILLE SC
29681-6629
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 864-356-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-04433
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: