KENDRA M RUCKMAN (NPI# 1942523600) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942523600 |
| Entity Type | Individual |
| Full Name | KENDRA M RUCKMAN |
| Other Name | KENDRA M DEWEY |
| Credential | PA-C |
| Practice Address |
205 E Nasa Blvd Melbourne FL 32901-1950 |
| Mailing Address |
3300 S Fiske Blvd Rockledge FL 32955-4306 |
| Practice Telephone | 3213615620 |
| Practice Fax Number | 3214343511 |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2020-03-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9106918 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 005799 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 013210300 | 05 | |
| FL | FL RR MEDICARE | P01165565 | 01 |
| FL | FL MEDICARE | GO616Y | 01 |
| FL | FLORIDA BLUE (BCBS) | Y0E5E | 01 |
| FL | AETNA | 9284904 | 01 |
| Street Address |
205 E NASA BLVD |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32901-1950 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467445031 | Anthony J. Barile | Internal Medicine | 205 E Nasa Blvd, Suite 200, Melbourne, FL 32901 | 2005-08-29 |
| 1518508001 | Nikki Ploetz | Physician Assistant | 205 E Nasa Blvd, Melbourne, FL 32901-1950 | 2019-10-05 |
| 1093034282 | Cynthia E. Sullivan | Nurse Practitioner | 205 E Nasa Blvd, Melbourne, FL 32901-1950 | 2010-05-27 |
| 1326278110 | Brent Stephens | Orthopaedic Surgery | 205 E Nasa Blvd, Melbourne, FL 32901-1950 | 2009-07-15 |
| 1518120344 | Lilia K Vinarsky | Physical Medicine & Rehabilitation | 205 E Nasa Blvd, Melbourne, FL 32901-1950 | 2008-07-02 |
| 1336238898 | Albert Esmailzadeh | Pain Medicine | 205 E Nasa Blvd, Suite 200, Melbourne, FL 32901-1950 | 2006-10-12 |
| 1841213105 | Susan Marie Glatter | Nurse Practitioner | 205 E Nasa Blvd, Melbourne, FL 32901-1950 | 2006-07-26 |
| 1598731200 | Elena V Barnes | Internal Medicine | 205 E Nasa Blvd, Melbourne, FL 32901-1950 | 2006-02-23 |
| 1679558720 | Edward W St. Mary | Orthopaedic Surgery | 205 E Nasa Blvd, Melbourne, FL 32901-1950 | 2005-12-13 |
| 1326022427 | Sukanya Pachaidee | Internal Medicine | 205 E Nasa Blvd, Suite 200, Melbourne, FL 32901-1950 | 2005-12-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467062943 | George Pappas | Anesthesiologist Assistant | 1775 W. Hibiscus Blvd., Ste 215, Melbourne, FL 32901 | 2020-08-09 |
| 1124676820 | Abbi Dell Lee | Behavioral Analyst | 3251 Engineering St, Melbourne, FL 32901 | 2019-08-27 |
| 1750856878 | Jeffrey Michael Cavanagh | Behavior Technician | 3251 Engineering Street, Melbourne, FL 32901 | 2018-10-04 |
| 1740766021 | Amanda Miller | Behavior Technician | 1885 W Hibiscus Blvd, Melbourne, FL 32901 | 2018-07-19 |
| 1396244406 | Dragen II LLC | Urology | 129 W Hibiscus Blvd Ste D, Melbourne, FL 32901 | 2018-02-03 |
| 1225550692 | Cabrit Psychotherapy Services LLC | Marriage & Family Therapist | 100 Rialto Place, Suite 700, Melbourne, FL 32901 | 2017-07-07 |
| 1487188058 | Project Response, Inc. | Clinic/Center | 747 S. Apollo Boulevard, Melbourne, FL 32901 | 2017-04-20 |
| 1184174575 | Paulette Swanson | Physical Therapist | 611 East Sheridan Rd, Melbourne, FL 32901 | 2016-10-10 |
| 1841747839 | Nicholas Wilson | Social Worker | 3661 S. Babcock St., Melbourne, FL 32901 | 2016-09-07 |
| 1467804278 | Nickolas Hetherington | Occupational Therapist | 1900 S Harbor City Blvd Ste 108, Melbourne, FL 32901 | 2016-07-05 |
| Find all providers in zip 32901 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164021895 | Breeyon Beachel | Physician Assistant | 4610 Beck Lake Trl Apt 1, Melbourne, FL 32901-8805 | 2020-10-23 |
| 1215535257 | Melissa Lee Amos | Physician Assistant | 3543 Providence Trace Dr, Melbourne, KY 41059-9203 | 2020-10-12 |
| 1720694326 | Michelle Smith | Physician Assistant | 2330 Andrea Ct, Melbourne, FL 32934-7601 | 2020-09-18 |
| 1093331787 | Alyssa Capawana | Physician Assistant | 6740 Shadow Creek Trl Apt 5410, Melbourne, FL 32940-6293 | 2020-06-18 |
| 1194359018 | Jarrod D Kearney | Physician Assistant | 580 N Wickham Rd Ste C, Melbourne, FL 32935-8400 | 2020-02-29 |
| 1104392851 | Rachel Margaret Martins | Physician Assistant | 1052 Fieldstone Dr, Melbourne, FL 32940-1633 | 2018-10-21 |
| 1497230320 | Mirabella M. Muller | Physician Assistant | 298 Michigan Ave Ste 101, Melbourne, FL 32901-3104 | 2018-09-26 |
| 1952743924 | Kristin Wagner | Physician Assistant | 2200 W. Eau Gallie Blvd., Suite 202c, Melbourne, FL 32935-3166 | 2013-07-19 |
| 1538485941 | David Luke Brightwell | Physician Assistant | 54 Tate Springs Rd, Melbourne, AR 72556-8633 | 2010-04-09 |
| 1679808588 | Maycie A Cruz | Physician Assistant | Family Practice of Suntree and Viera, 2 Suntree Place, Melbourne, FL 32940 | 2009-10-09 |
| Find all providers in MELBOURNE | ||||
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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.