Healthcare Provider Details

I. General information

NPI: 1629516299
Provider Name (Legal Business Name): VIRGINIA KATHLEEN RUTLEDGE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIRGINIA KATHLEEN CHESTER CRNP

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 S VALLEY AVE STE B
COLLINSVILLE AL
35961-3263
US

IV. Provider business mailing address

PO BOX 890
COLLINSVILLE AL
35961-0890
US

V. Phone/Fax

Practice location:
  • Phone: 256-524-3090
  • Fax: 256-524-2885
Mailing address:
  • Phone: 256-524-3090
  • Fax: 256-524-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-136284
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: