Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | PENDING | TN |
NPI | 1003381484 |
---|---|
Provider Name | Kristi Michelle Rutherford |
First Address | Seymour, TN 37865-3908 |
Second Address | Seymour, TN 37865-3908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2018 |
Last Update Date | 11/10/2018 |