Provider Demographics
NPI:1932480902
Name:KINGKADE, RUTH POWELL (RN CDIABETES EDUCATO)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:POWELL
Last Name:KINGKADE
Suffix:
Gender:F
Credentials:RN CDIABETES EDUCATO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359-3036
Mailing Address - Country:US
Mailing Address - Phone:502-484-3412
Mailing Address - Fax:502-484-0864
Practice Address - Street 1:510 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-3036
Practice Address - Country:US
Practice Address - Phone:502-484-3412
Practice Address - Fax:502-484-0864
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1083125163W00000X
KY21110226163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse