Provider Demographics
NPI:1134419799
Name:THRELKELD, RUTH (FNP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:THRELKELD
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 1:501 N ROUTE B
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65255-9266
Mailing Address - Country:US
Mailing Address - Phone:573-696-0500
Mailing Address - Fax:573-696-0509
Practice Address - Street 1:501 N ROUTE B
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65255-9266
Practice Address - Country:US
Practice Address - Phone:573-696-0500
Practice Address - Fax:573-696-0509
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily