Individual
KELLEY RUTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1501 SAN PEDRO DR. SE, MEDICINE SERVICE (111), ALBUQUERQUE, NM 87108
(505) 265-1711
Mailing address
1501 SAN PEDRO DR. SE, MEDICINE SERVICE (111), ALBUQUERQUE, NM 87108
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2019-0090
NM
Other
Enumeration date
10/23/2019
Last updated
10/23/2019
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