Provider Information for 1366968075
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KIMBERLY RUTHARDT
Sex: Female
NPI: 1366968075
Last Updated: 2019-05-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1366968075 | ||||||||||||
| Enumeration Date | 2017-08-15 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 5865 LUBBOCK, TX 79408-5865 United States Phone: 806-743-2898 | Fax:806-743-2787 | ||||||||||||
| Primary Practice Address | 6610 QUAKER AVE LUBBOCK, TX 79413 United States Phone: 806-743-4270 | Fax:806-743-9097 | ||||||||||||
| Secondary Practice Address(es) | 6610 QUAKER AVE 6610 QUAKER AVE STOP 7118 5006 100TH ST | ||||||||||||
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