MEDICARE: TERI RUTHERFORD FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	128736	TX

General Provider Information

NPI Number	:	1063885085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI RUTHERFORD FNP-C

Provider Business Mailing Address
First Line	:	1219 COUNTY ROAD 203
Second Line	:
City	:	COLLINSVILLE
State	:	TX
Zip	:	76233-2190
Country	:	US
Telephone Number	:	972-658-3741
Fax Number	:

Provider Business Practice Location Address
First Line	:	8080 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-1838
Country	:	US
Telephone Number	:	972-658-3741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	01/03/2017

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Directions to “ TERI RUTHERFORD FNP-C” Practice Location

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