Individual
DR. RUTH KELLUM FREDERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
11722
MS
2084N0400X
Neurology Physician
Primary
11722
MS
2084N0400X
Neurology Physician
COVID19-TMP-427
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00113670
—
MS
Enumeration date
05/08/2006
Last updated
04/04/2025
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