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General NPI Number Information
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NPI Number | 1326492711
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Entity Type | Individual
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Provider Name | JESSICA L RUTLEDGE LM CPM CLC
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Gender | Female
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 1503 STRATFORD DR
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City | MANSFIELD
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State | TX
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Zip | 76063-3357
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Country | US
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Telephone | 682-331-9625
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Fax |
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Provider Business Mailing Address
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Address Line | 2413 VIA PALERMO APARTMENT 1611
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City | FORT WORTH
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State | TX
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Zip | 76109-6548
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Country | US
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Telephone | 682-331-9625
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 881901
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 99558
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License Number State | TX
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