Individual
KYLE ELLIS RUCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
630 W MAPLE ST, FARMINGTON, NM 87401-6113
(505) 609-6349
(505) 609-2259
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA2020-0115
NM
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/05/2020
Last updated
11/12/2024
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