Provider Demographics
NPI:1710758743
Name:PEROCHO, RUBY (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:PEROCHO
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2927
Mailing Address - Country:US
Mailing Address - Phone:913-642-6330
Mailing Address - Fax:
Practice Address - Street 1:7501 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2927
Practice Address - Country:US
Practice Address - Phone:913-642-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023047871363LF0000X
KS53-82712-081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily