Provider Demographics
NPI:1760156954
Name:CARRUTH, PHYLANA K (RN)
Entity Type:Individual
Prefix:
First Name:PHYLANA
Middle Name:K
Last Name:CARRUTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:CORNWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 W B ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3501
Mailing Address - Country:US
Mailing Address - Phone:479-968-1777
Mailing Address - Fax:470-967-1111
Practice Address - Street 1:915 W B ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3501
Practice Address - Country:US
Practice Address - Phone:479-968-1777
Practice Address - Fax:479-967-1111
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR104827163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice