| Doctor Name: | KELLY A RUCKNO |
| NPI Number: | 1073647319 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 1629 |
| Business Practice Address: | 20 Ladyslipper Ln Hilton Head Island, SC - 299261372 |
| Business Phone Number: | 8436827116 |
| Business Fax Number: | 8436897084 |
| Mailing Address: | 29 Mcintosh Rd, HILTON HEAD ISLAND |
| State: | SC |
| Postal Code: | 299262006 |
| Phone Number: | 8436827126 |
| Fax Number: | 8436897084 |
| NPI Enumeration Date: | 03/16/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1629 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |