Provider Demographics
NPI:1265540850
Name:RUTHERFORD, MARY ELIZABETH (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE. 101
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4693
Mailing Address - Country:US
Mailing Address - Phone:931-553-4161
Mailing Address - Fax:931-553-4176
Practice Address - Street 1:1820 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4693
Practice Address - Country:US
Practice Address - Phone:931-553-4161
Practice Address - Fax:931-553-4161
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPRN7209163WP0809X
TNARPN7209363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908530Medicaid
TN4104879OtherBLUE CROSS BLUE SHIELD
TN4104879OtherBLUE CROSS BLUE SHIELD
TN3908530Medicaid