Provider Demographics
NPI:1174015002
Name:RUTLEDGE, STACY (FNP-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5328 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7506
Mailing Address - Country:US
Mailing Address - Phone:318-397-3636
Mailing Address - Fax:318-397-3639
Practice Address - Street 1:5328 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7506
Practice Address - Country:US
Practice Address - Phone:318-396-3636
Practice Address - Fax:318-397-3639
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine