Basic Information
| Provider Information | |||||||||
| NPI: | 1023085800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUTLEDGE | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | MORCOM | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465955 | ||||||||
| FaxNumber: | 7574465196 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 FAIRFAX AVE | ||||||||
| Address2: | 118 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465955 | ||||||||
| FaxNumber: | 7574465196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 09/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024076754 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 0001076754 | VA | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | -002 -003 | 01 | VA | TRICARE/CHAMPUS | OTHER | 007790929 | 05 | VA | MEDICAID | 04017 | 01 | NC | NC BC/BS | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | 7004017 | 05 | NC | MEDICAID | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 42485N | 01 | VA | SENTARA OPTIMA | OTHER |