1689726648 NPI number — MRS. ALLYSON TORRENCE RUTLEDGE RD LDN

Table of content: MRS. ALLYSON TORRENCE RUTLEDGE RD LDN (NPI 1689726648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689726648 NPI number — MRS. ALLYSON TORRENCE RUTLEDGE RD LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTLEDGE
Provider First Name:
ALLYSON
Provider Middle Name:
TORRENCE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TORRENCE
Provider Other First Name:
ALLYSON
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689726648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19809 B NORTH COVE ROAD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
CORNELIUS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-895-9865
Provider Business Mailing Address Fax Number:
704-895-9870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16501 D NORTHCROSS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-895-9865
Provider Business Practice Location Address Fax Number:
704-895-9870
Provider Enumeration Date:
01/18/2007

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: 133V00000X , with the licence number:  L001415 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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