Provider Demographics
NPI:1801369921
Name:AYRES, RUBY LEE
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:LEE
Last Name:AYRES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W FARM ROAD 42
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HOPE
Mailing Address - State:MO
Mailing Address - Zip Code:65725-9157
Mailing Address - Country:US
Mailing Address - Phone:417-838-5675
Mailing Address - Fax:
Practice Address - Street 1:700 CHIEF EDDIE HOFFMAN
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK188570363LF0000X
MO2018043748363LF0000X
WAAP61002103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1737077Medicaid