Provider Demographics
NPI:1629300231
Name:RUTHERFORD, JAMI CHINICHE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:CHINICHE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 DRINKWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SAINT LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-2507
Mailing Address - Country:US
Mailing Address - Phone:228-395-1255
Mailing Address - Fax:228-395-1256
Practice Address - Street 1:149 DRINKWATER BLVD
Practice Address - Street 2:
Practice Address - City:BAY SAINT LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-2507
Practice Address - Country:US
Practice Address - Phone:228-395-1255
Practice Address - Fax:228-395-1256
Is Sole Proprietor?:No
Enumeration Date:2010-02-06
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily