Provider Demographics
NPI:1801937818
Name:RUTAN, KRISTY MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:MARIE
Last Name:RUTAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4812
Mailing Address - Country:US
Mailing Address - Phone:828-254-8883
Mailing Address - Fax:828-253-2024
Practice Address - Street 1:100 VICTORIA RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4812
Practice Address - Country:US
Practice Address - Phone:828-254-8883
Practice Address - Fax:828-253-2024
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC104037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant