Provider Demographics
NPI:1447564109
Name:RUTT, PHILLIS JEWELL (NP-C)
Entity Type:Individual
Prefix:
First Name:PHILLIS
Middle Name:JEWELL
Last Name:RUTT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:PHILLIS
Other - Middle Name:JEWELL
Other - Last Name:RUTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:4900 S MONACO ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-563-2784
Mailing Address - Fax:303-563-2781
Practice Address - Street 1:799 E HAMPDEN AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2762
Practice Address - Country:US
Practice Address - Phone:303-788-6490
Practice Address - Fax:303-788-5451
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-10128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04427092Medicaid
CO01277359Medicaid
CO11721758Medicaid
CO11721758Medicaid