Active NPI
Kelley Rutter, PA-C
- Physician Assistant
- Albuquerque, NM
National Provider Identifier
1275176141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2019-0090
- Practice address
- 1501 San Pedro Dr. SE
Medicine Service (111)
Albuquerque, NM 87108 - Phone
- (505) 265-1711
- NPI assigned
- Oct 23, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2019-0090 | NM | Primary |
Addresses
Primary practice location
1501 San Pedro Dr. SE
Medicine Service (111)
Albuquerque, NM 87108
Mailing address
1501 San Pedro Dr. SE
Medicine Service (111)
Albuquerque, NM 87108
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2019-0090 | NM | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571788800000",
"number": "1275176141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 SAN PEDRO DR. SE",
"address_2": "MEDICINE SERVICE (111)",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 SAN PEDRO DR. SE",
"address_2": "MEDICINE SERVICE (111)",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87108",
"telephone_number": "505-265-1711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUTTER",
"first_name": "KELLEY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-23",
"last_updated": "2019-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NM",
"license": "PA2019-0090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.