Provider Demographics
NPI:1831164383
Name:BLAIR-RUTHERFORD, KRISTIE LYNN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:LYNN
Last Name:BLAIR-RUTHERFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10542 OLD BRASSLE DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-5802
Mailing Address - Country:US
Mailing Address - Phone:980-207-2004
Mailing Address - Fax:
Practice Address - Street 1:1718 E 4TH ST STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3193
Practice Address - Country:US
Practice Address - Phone:704-384-7292
Practice Address - Fax:704-384-8880
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRN1091690 ARNP4785P363LF0000X
NC5004405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily