Provider Demographics
NPI:1770771636
Name:ASHLOCK-RUDA, DELORIS ELAINE (FNP)
Entity type:Individual
Prefix:
First Name:DELORIS
Middle Name:ELAINE
Last Name:ASHLOCK-RUDA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:ASHLOCK-RUDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1150 STATE HIGHWAY 248 STE 202
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3729
Practice Address - Country:US
Practice Address - Phone:417-348-8964
Practice Address - Fax:417-336-0275
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO136833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
736536OtherHEALTHLINK
721981OtherHEALTHLINK
721981OtherHEALTHLINK