Individual
MS. MARYSA BRAYE RUEFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
250 FOUNTAIN CT, LEXINGTON, KY 40509-1888
(859) 263-4444
(859) 977-2303
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1122
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000552175
ANTHEM BLUE CROSS & BLUE SHIELD
KY
05
—
7100110660
—
KY
01
—
C60350
CUMBERLAND HEALTHCARE
—
Enumeration date
02/11/2008
Last updated
10/11/2023
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