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NPI Code Detail

MEDICARE: KELSEY CAMPBELL RUTTER APRN

MEDICARE: KELSEY CAMPBELL RUTTER APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner26502SC

General Provider Information

NPI Number : 1518686674
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY CAMPBELL RUTTER APRN
Provider Business Mailing Address
First Line : 1330 DUTCH FORK RD
Second Line :
City : IRMO
State : SC
Zip : 29063-8825
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1330 DUTCH FORK RD
Second Line :
City : IRMO
State : SC
Zip : 29063-8825
Country : US
Telephone Number : 803-749-1666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2022
Last Update Date : 08/23/2022

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