Provider Demographics
NPI:1356486526
Name:RUIA, KERRY JEAN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:JEAN
Last Name:RUIA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2336
Mailing Address - Country:US
Mailing Address - Phone:315-732-6100
Mailing Address - Fax:315-732-5542
Practice Address - Street 1:95 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2357
Practice Address - Country:US
Practice Address - Phone:315-732-6100
Practice Address - Fax:315-732-5542
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332299363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner