1134285448 NPI number — MRS. RUTH CROSBY WALKUP APRN,BC

Table of content: MRS. RUTH CROSBY WALKUP APRN,BC (NPI 1134285448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134285448 NPI number — MRS. RUTH CROSBY WALKUP APRN,BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKUP
Provider First Name:
RUTH
Provider Middle Name:
CROSBY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN,BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134285448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 S VAN LINGLE MUNGO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAGELAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29728-1950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-675-5000
Provider Business Mailing Address Fax Number:
843-675-5003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 KINTYRE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28112-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-448-0865
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  5004036 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 2561 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP1271 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7006019 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com