Provider Demographics
NPI:1326043134
Name:ECHOLS, RUTHETTA WHITFIELD (PA)
Entity Type:Individual
Prefix:MRS
First Name:RUTHETTA
Middle Name:WHITFIELD
Last Name:ECHOLS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:445 WESTERN BLVD
Mailing Address - Street 2:STE L
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6852
Mailing Address - Country:US
Mailing Address - Phone:910-546-6638
Mailing Address - Fax:910-333-8985
Practice Address - Street 1:445 WESTERN BLVD STE L
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6852
Practice Address - Country:US
Practice Address - Phone:910-546-6638
Practice Address - Fax:910-333-8985
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752716CMedicare ID - Type UnspecifiedCIGNA MEDICARE
598435Medicare UPIN