Healthcare Provider Details

I. General information

NPI: 1992290654
Provider Name (Legal Business Name): NATESSA RAMEY RUTHERFORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 ROCKFORD ST STE 1400
MOUNT AIRY NC
27030-6594
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-673-6560
  • Fax: 336-719-0494
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5019422
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0001251526
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: