Healthcare Provider Details

I. General information

NPI: 1609585348
Provider Name (Legal Business Name): CHRISTOPHER ADAM RUCKMAN APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WHITE MOSS PL
FRANKLIN TN
37064-8627
US

IV. Provider business mailing address

311 WHITE MOSS PL
FRANKLIN TN
37064-8627
US

V. Phone/Fax

Practice location:
  • Phone: 803-467-3506
  • Fax:
Mailing address:
  • Phone: 803-467-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32944
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number32944
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32944
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: