MICHIEL BRENT RUDDER (NPI# 1841287109) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841287109 |
| Entity Type | Individual |
| Full Name | MICHIEL BRENT RUDDER |
| Credential | FNP MSW |
| Practice Address |
622 West Market Street Bolivar TN 38008 |
| Mailing Address |
Po Box 11567 Jackson TN 38308-0126 |
| Practice Telephone | 7316584500 |
| Practice Fax Number | 7316584545 |
| Mailing Telephone | 7316610086 |
| Mailing Fax Number | 7316619702 |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2011-10-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | RN131561 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3909409 | 05 | |
| DEA | MR0784276 | 01 |
| Street Address |
622 WEST MARKET STREET |
| City | BOLIVAR |
| State | TN |
| Zip Code | 38008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720639172 | Shanna Shackelford | Nurse Practitioner | 11100 Old Hwy 64 W, Bolivar, TN 38008 | 2019-09-26 |
| 1598326233 | Holly Brooke Shourd | Family Medicine | 1359 W Market St., Bolivar, TN 38008 | 2019-06-24 |
| 1992299234 | Angela Dawn Haynes | Registered Nurse | 10825 Hwy 64w, Bolivar, TN 38008 | 2018-06-20 |
| 1326595919 | Ashley Evon Jowers | Nurse Practitioner | 11100 Old Hwy 64 West, Bolivar, TN 38008 | 2016-09-01 |
| 1942458344 | Anita Pearl Johnson | Physical Therapy Assistant | 700 Knuckolls Ave, Bolivar, TN 38008 | 2008-08-28 |
| 1841340007 | State of Tennessee | Public Health or Welfare | 10825 Old Hwy 64, Bolivar, TN 38008 | 2007-01-11 |
| 1164479721 | Betty Ragon Lenoir | Physical Therapist | 789 Tennessee St, Bolivar, TN 38008 | 2006-05-28 |
| 1689623050 | County of Hardeman | Ambulance | 735 Naylor St, Bolivar, TN 38008 | 2006-05-10 |
| 1982606497 | Richard Mast Reinhard IIi | Pediatrics | 629 Nuckolls Rd, Bolivar, TN 38008 | 2005-08-15 |
| 1700288024 | Elizabeth Gault Ligon | Optometrist | 725 W Market St, Bolivar, TN 38008 | 2014-09-17 |
| Find all providers in zip 38008 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598326233 | Holly Brooke Shourd | Family Medicine | 1359 W Market St., Bolivar, TN 38008 | 2019-06-24 |
| 1134255078 | Robert Wayne Dunavant | Family Medicine | 610 Nuckolls Rd, Bolivar, TN 38008-1532 | 2007-02-26 |
| 1326110818 | George J Heinz IIi | Family Medicine | 1500 N. Oakland Ave., Bolivar, MO 65613 | 2006-11-14 |
| 1871692798 | Greg Link | Family Medicine | 3817 S Springfield Ave, Suite 140, Bolivar, MO 65613-9129 | 2006-09-21 |
| 1114930716 | Monte R Kahler | Family Medicine | 1125 N Butterfield, Bolivar, MO 65613 | 2006-08-14 |
| 1023029998 | Kristopher J Kaufmann | Family Medicine | 1125 N Butterfield Rd, Bolivar, MO 65613-1056 | 2006-08-10 |
| 1346283413 | Associates In Medicine, Inc | Family Medicine | 630 E Buffalo St, Bolivar, MO 65613-2619 | 2006-06-14 |
| 1417901935 | Juris Peteris Simanis | Family Medicine | 1155 W. Parkview Street, Suite 2d, Bolivar, MO 65613-7800 | 2006-05-20 |
| 1346201274 | Stacey A Robertson | Family Medicine | 802 Mckinley St, Bolivar Medical Center, Bolivar, PA 15923 | 2006-03-30 |
| 1649248840 | Mark Andrew Hillyer | Family Medicine | 10724 State Route 212 Ne, Bolivar, OH 44612-8740 | 2006-03-14 |
| Find all providers in BOLIVAR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.