Provider Demographics
NPI:1841972205
Name:RUTHERFORD, JORDAIN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JORDAIN
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 W MARCH LN STE 250
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8222
Mailing Address - Country:US
Mailing Address - Phone:209-290-1700
Mailing Address - Fax:209-290-3633
Practice Address - Street 1:2509 W MARCH LN STE 250
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8222
Practice Address - Country:US
Practice Address - Phone:209-290-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014277363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health