Provider Demographics
NPI:1063885085
Name:RUTHERFORD, TERI (FNP-C)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 COUNTY ROAD 203
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76233-2190
Mailing Address - Country:US
Mailing Address - Phone:972-658-3741
Mailing Address - Fax:
Practice Address - Street 1:8080 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1838
Practice Address - Country:US
Practice Address - Phone:972-658-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily