Provider Demographics
NPI:1932676384
Name:KERSHAW, RUTH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:KERSHAW
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 21ST AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1259
Mailing Address - Country:US
Mailing Address - Phone:415-622-5047
Mailing Address - Fax:
Practice Address - Street 1:3838 CALIFORNIA ST RM 715
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1509
Practice Address - Country:US
Practice Address - Phone:415-668-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant