Provider Demographics
NPI:1114921632
Name:RUGGLE, KEVIN P (AUD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:RUGGLE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 HYLTON HEIGHTS RD
Mailing Address - Street 2:STE 105
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2812
Mailing Address - Country:US
Mailing Address - Phone:785-537-4005
Mailing Address - Fax:
Practice Address - Street 1:1213 HYLTON HEIGHTS RD
Practice Address - Street 2:STE 105
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2812
Practice Address - Country:US
Practice Address - Phone:785-537-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2012-05-03
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
KS01002231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100228130BMedicaid
KS115309Medicare ID - Type UnspecifiedAU.D.