Provider Demographics
NPI:1881254225
Name:RUCKER-SMITH, AIRELLE (DNP, CRNP)
Entity type:Individual
Prefix:DR
First Name:AIRELLE
Middle Name:
Last Name:RUCKER-SMITH
Suffix:
Gender:F
Credentials:DNP, CRNP
Other - Prefix:DR
Other - First Name:AIRELLE
Other - Middle Name:
Other - Last Name:RUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CRNP
Mailing Address - Street 1:9841 WASHINGTONIAN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-7350
Mailing Address - Country:US
Mailing Address - Phone:240-720-7797
Mailing Address - Fax:
Practice Address - Street 1:9841 WASHINGTONIAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-7350
Practice Address - Country:US
Practice Address - Phone:240-720-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197994363L00000X, 363LA2200X, 363LG0600X, 363LW0102X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health