Provider Demographics
NPI:1679903710
Name:MCCLESKEY, RUBY (APRN)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:MCCLESKEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 OXFORD PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2922
Mailing Address - Country:US
Mailing Address - Phone:502-609-3581
Mailing Address - Fax:
Practice Address - Street 1:950 S 1ST ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2202
Practice Address - Country:US
Practice Address - Phone:502-585-9444
Practice Address - Fax:502-585-9466
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0388106H00000X
KY3002705364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100281360Medicaid