Provider Demographics
NPI:1508366782
Name:ROY, RUBY ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:RUBY ANN
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 CANNON VIEW LN APT 11
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-4567
Mailing Address - Country:US
Mailing Address - Phone:407-230-2532
Mailing Address - Fax:
Practice Address - Street 1:1123 CANNON VIEW LN APT 11
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4567
Practice Address - Country:US
Practice Address - Phone:407-230-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS57-77958-081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty