Provider Demographics
NPI:1508384512
Name:RUTIGLIANO, MEGAN LEILA SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEILA SUE
Last Name:RUTIGLIANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LEILA SUE
Other - Last Name:WAKEFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1401 HARRODSBURG RD STE C100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1780
Mailing Address - Country:US
Mailing Address - Phone:859-278-4960
Mailing Address - Fax:859-277-2840
Practice Address - Street 1:1401 HARRODSBURG RD STE C100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1780
Practice Address - Country:US
Practice Address - Phone:859-278-4960
Practice Address - Fax:859-277-2840
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA3044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant