Provider Demographics
NPI:1134675978
Name:RUIZ, KATHERINE PEARSON (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PEARSON
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-0189
Mailing Address - Country:US
Mailing Address - Phone:804-526-6062
Mailing Address - Fax:804-526-9094
Practice Address - Street 1:110 DUNLOP CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1818
Practice Address - Country:US
Practice Address - Phone:804-526-6062
Practice Address - Fax:804-526-9094
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-005428363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical