Provider Demographics
NPI:1063247815
Name:RUFENER, KELLIE
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:RUFENER
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 1:291 EAST ST SW
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-9787
Mailing Address - Country:US
Mailing Address - Phone:740-819-1826
Mailing Address - Fax:
Practice Address - Street 1:291 EAST ST SW
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:OH
Practice Address - Zip Code:44612-9787
Practice Address - Country:US
Practice Address - Phone:740-819-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator