Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kyle Ellis Ruckman, PA-C

Individual provider Physician Assistant · NPI 1952902934

Kyle Ellis Ruckman, PA-C is a Physician Assistant in Farmington, New Mexico. Graduated from Boston University School of Medicine in 2020, 6 years ago. Practices with San Juan Regional Medical Center, Inc, a 231-clinician group and accepts Medicare assignment. Licensed in New Mexico.

Years since qualifying
6
Trained at
Boston University School of Medicine
Licensed in
NM
In the registry since
2020
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

630 W Maple St
Farmington, NM 87401-6113
Phone: (505) 609-6349
Fax: (505) 609-2259
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Physician Assistant Taxonomy 363A00000X · Licence PA2020-0115 (NM)

Record details

NPI number1952902934
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedNovember 5, 2020
Last updated in NPPESNovember 12, 2024
Certification dateNovember 12, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolBOSTON UNIVERSITY SCHOOL OF MEDICINE
Graduated 2020 (6 years in practice)
Group practice San Juan Regional Medical Center, Inc. — 231 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Farmington