Provider Demographics
NPI:1134285448
Name:WALKUP, RUTH CROSBY (APRN,BC)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:CROSBY
Last Name:WALKUP
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S VAN LINGLE MUNGO BLVD
Mailing Address - Street 2:
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728-1950
Mailing Address - Country:US
Mailing Address - Phone:843-675-5000
Mailing Address - Fax:843-675-5003
Practice Address - Street 1:504 KINTYRE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4111
Practice Address - Country:US
Practice Address - Phone:803-448-0865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004036363LF0000X
SC2561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1271Medicaid
NC7006019Medicaid