Individual
SIR JOHNATHAN RUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
635 W WILLIE MORRIS PKWY, YAZOO CITY, MS 39194-7702
(601) 638-0031
(601) 638-1778
Mailing address
635 W WILLIE MORRIS PKWY, YAZOO CITY, MS 39194-7702
(601) 638-0031
(601) 638-1778
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018215
—
MS
Enumeration date
03/13/2019
Last updated
03/13/2019
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