Provider Demographics
NPI:1629009428
Name:RUTLEDGE, JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18452 NELSON PL NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20730 BOND ROAD NE
Practice Address - Street 2:#205
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9000
Practice Address - Country:US
Practice Address - Phone:360-697-1957
Practice Address - Fax:360-779-9224
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8325946Medicaid
WAG8880795Medicare PIN
WAS50368Medicare UPIN
WA8325946Medicaid