Khoriasa Marie Ruffell, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

332724-01 Issued in NY

Practice address

6 Walnut Dr
Pleasant Valley, NY 12569-6934

Phone

(845) 366-9212

NPI assigned

Apr 30, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Khoriasa Marie Black Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1154119808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 SUFFERN PL STE A",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109015566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 WALNUT DR",
            "city": "PLEASANT VALLEY",
            "state": "NY",
            "postal_code": "125696934",
            "telephone_number": "845-366-9212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUFFELL",
        "first_name": "KHORIASA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-30",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "332724-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KHORIASA",
            "last_name": "BLACK",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gina Rosalie Ricker
• Robert Rosenzweig, MD, PC
• Elyse Robles
• Barbara Roth, RPH
• James Edwin Ruffell Jr., LPN
• Saint Francis Physician Services, PLLC
• Kathleen Elizabeth Sawicki, PHARM. D.
• Schwartz & Patten, DDS, PC
• Michael Steven Schwartz, D.D.S.
• Sondra L Scott, LCSW-R

• Licensed Practical Nurse in Pleasant Valley, NY
• Providers in Pleasant Valley, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.