Provider Demographics
NPI:1447880620
Name:RUFFIN, TAKEYSHA
Entity type:Individual
Prefix:
First Name:TAKEYSHA
Middle Name:
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1626
Mailing Address - Country:US
Mailing Address - Phone:334-305-1508
Mailing Address - Fax:334-803-8122
Practice Address - Street 1:545 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1626
Practice Address - Country:US
Practice Address - Phone:334-836-0217
Practice Address - Fax:334-803-8122
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL84-1947398Medicaid