Provider Demographics
NPI:1205231065
Name:RUELLE, ROXZY R (PA)
Entity Type:Individual
Prefix:
First Name:ROXZY
Middle Name:R
Last Name:RUELLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29710 URGENT CARE DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9595
Mailing Address - Country:US
Mailing Address - Phone:251-626-3782
Mailing Address - Fax:251-626-0787
Practice Address - Street 1:29710 URGENT CARE DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9595
Practice Address - Country:US
Practice Address - Phone:251-626-3782
Practice Address - Fax:251-626-0787
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1422363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL512-21005OtherBCBS OF AL
FLJTT1ZOtherBCBS