Individual
CRYSTAL D RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
725 N PIKE ST, GRAFTON, WV 26354-1270
(304) 265-4909
(304) 265-4915
Mailing address
PO BOX 35, NEWBURG, WV 26410-0035
(304) 892-2828
(304) 892-2927
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
461
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3910005605
—
WV
Enumeration date
09/20/2006
Last updated
02/25/2019
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