Fredericks, Ruth Kellum
Fredericks, Ruth Kellum is an sole proprietor health care provider with primary practice located at 971 Lakeland Dr Suite 557, Jackson MS 39216-4643. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Neurology is her primary health care specialty. Fredericks, Ruth Kellum can be contacted via phone (601) 200-4560.Contact Information
Primary practice address
971 Lakeland Dr Suite 557
Jackson MS 39216-4643
Phone: (601) 200-4560
Fax: (601) 326-4632
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 11722 | Mississippi |
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | COVID19-TMP-427 | Louisiana |
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 11722 | Mississippi |
Profile Details
| NPI number | 1730138843 |
|---|---|
| LBN Legal business name | Fredericks, Ruth Kellum |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 8th, 2006 |
| Last updated | Dec 23rd, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730138843 | NPPES |
| Mississippi | MEDICAID | 00113670 |
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