Provider Demographics
NPI:1003381484
Name:RUTHERFORD, KRISTI MICHELLE (CPNP)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:MICHELLE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:LEDLOW
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP
Mailing Address - Street 1:212 PHOENIX CT STE 1
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-3908
Mailing Address - Country:US
Mailing Address - Phone:865-577-6475
Mailing Address - Fax:865-577-7942
Practice Address - Street 1:212 PHOENIX CT STE 1
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-3908
Practice Address - Country:US
Practice Address - Phone:865-577-6475
Practice Address - Fax:865-577-7942
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPENDING363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics