Healthcare Provider Details

I. General information

NPI: 1275968950
Provider Name (Legal Business Name): LINDSEY RAE RUGGLES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9300
US

IV. Provider business mailing address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9300
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6741
  • Fax:
Mailing address:
  • Phone: 304-429-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1112750
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: