Provider Demographics
NPI:1144741794
Name:RUFFIN, KAITLIN MIZE (CPNP-PC, RN)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MIZE
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:CPNP-PC, RN
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:MIZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC, RN
Mailing Address - Street 1:7755 ACC BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8631
Mailing Address - Country:US
Mailing Address - Phone:919-482-5711
Mailing Address - Fax:
Practice Address - Street 1:91 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-9590
Practice Address - Country:US
Practice Address - Phone:252-451-3100
Practice Address - Fax:252-937-3108
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC259034363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC259034OtherNC LICENSE
NCNCY234AOtherMEDICARE
NC19R06OtherBCBS OF NC
NC1144741794Medicaid