Basic Information
| Provider Information | |||||||||
| NPI: | 1407340128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUTELONIS | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | ELIZABETH SCHUELKE | ||||||||
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| Credential: | RN, BSN, MSN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT. 453, PO BOX 1000 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285752625 | ||||||||
| FaxNumber: | 8283502174 | ||||||||
| Practice Location | |||||||||
| Address1: | 1128 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035938273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2018 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP138722 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1407340128 | 05 | TX | MEDICAID | 759811 | 01 | TX | MEDICARE PTAN | OTHER |