Provider Demographics
NPI:1255756375
Name:RUDDY, JAY (NP)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:RUDDY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 W NORTH DOWN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-2060
Mailing Address - Country:US
Mailing Address - Phone:989-348-0800
Mailing Address - Fax:989-344-5725
Practice Address - Street 1:1010 W NORTH DOWN RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-2060
Practice Address - Country:US
Practice Address - Phone:989-348-0800
Practice Address - Fax:989-344-5725
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704208356363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health