Provider Demographics
NPI:1922278696
Name:RULIFFSON, KATHRYN RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RENEE
Last Name:RULIFFSON
Suffix:
Gender:F
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 1:2488 E GLENHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8204
Mailing Address - Country:US
Mailing Address - Phone:540-421-9822
Mailing Address - Fax:
Practice Address - Street 1:2488 E GLENHAVEN DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8204
Practice Address - Country:US
Practice Address - Phone:540-421-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53818363A00000X
AZ7447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant