Provider Demographics
NPI:1225718448
Name:KIKER, RUBY ELLEN (MPH, CPM, LDM)
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:ELLEN
Last Name:KIKER
Suffix:
Gender:F
Credentials:MPH, CPM, LDM
Other - Prefix:MISS
Other - First Name:RUBY
Other - Middle Name:ELLEN
Other - Last Name:TRASK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2312 NW GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2414
Mailing Address - Country:US
Mailing Address - Phone:503-867-3951
Mailing Address - Fax:
Practice Address - Street 1:2312 NW GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2414
Practice Address - Country:US
Practice Address - Phone:503-867-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10231842176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife