Individual
KRISTY LEE ANN CARRUTHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
101 E WOOD ST, 2ND FLOOR/RADIOLOGY, SPARTANBURG, SC 29303-3040
(864) 560-6522
(888) 972-8644
Mailing address
PO BOX 631341, CINCINNATI, OH 45263-1341
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110002023
VA
363A00000X
Physician Assistant
Primary
PA1219
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0628PA
—
SC
01
—
P00648636
RAILROAD MEDICARE #
SC
01
—
P00754297
RAILROAD MC ID-RSFPN
SC
Enumeration date
07/14/2006
Last updated
11/28/2023
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