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General NPI Number Information
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NPI Number | 1164275566
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Entity Type | Individual
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Provider Name | KALI RENEE RUTHERFORD PA
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Gender | Female
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 2707 JACKSBORO PIKE STE 2
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City | JACKSBORO
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State | TN
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Zip | 37757-2752
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Country | US
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Telephone | 423-437-8576
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Fax |
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Provider Business Mailing Address
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Address Line | 2055 GATEHOUSE LN
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City | POWELL
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State | TN
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Zip | 37849-6301
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Country | US
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Telephone | 865-202-3252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5906
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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