Provider Demographics
NPI:1326492711
Name:RUTLEDGE, JESSICA L (RN, BSN, CLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:RN, BSN, CLC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:HUTCHISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2413 VIA PALERMO
Mailing Address - Street 2:APARTMENT 1611
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-6548
Mailing Address - Country:US
Mailing Address - Phone:682-331-9625
Mailing Address - Fax:
Practice Address - Street 1:2413 VIA PALERMO
Practice Address - Street 2:APARTMENT 1611
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-6548
Practice Address - Country:US
Practice Address - Phone:682-331-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX881901163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant