Provider Demographics
NPI:1023085800
Name:RUTLEDGE, CAROLYN MORCOM (FNP)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MORCOM
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:118
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024076754363LF0000X
VA0001076754163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-002 -003OtherTRICARE/CHAMPUS
VA007790929Medicaid
NC04017OtherNC BC/BS
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
NC7004017Medicaid
VAPAROtherCORVEL/CORCARE
VA42485NOtherSENTARA OPTIMA
VAPAROtherVIRGINIA PREMIER HEALTH
VAP47371Medicare UPIN