Provider Demographics
NPI:1982588422
Name:RUTLEDGE, IYSIS CHANEL
Entity type:Individual
Prefix:
First Name:IYSIS
Middle Name:CHANEL
Last Name:RUTLEDGE
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 1:1005 SONORAN CIR APT 6104
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-6352
Mailing Address - Country:US
Mailing Address - Phone:843-331-8724
Mailing Address - Fax:
Practice Address - Street 1:1005 SONORAN CIR APT 6104
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-6352
Practice Address - Country:US
Practice Address - Phone:843-331-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant