Healthcare Provider Details

I. General information

NPI: 1134675978
Provider Name (Legal Business Name): KATHERINE RUIZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HOSPITAL DR
MT PLEASANT SC
29464-3255
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-1341
  • Fax:
Mailing address:
  • Phone: 888-472-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110-005428
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4880
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: