Individual
JONATHAN HOWELL RUTHERFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
155 CALLE PORTAL STE 300, SIERRA VISTA, AZ 85635-2900
(520) 459-3011
(520) 364-4261
Mailing address
1205 N F AVE, DOUGLAS, AZ 85607-1920
(520) 364-6852
(520) 364-4261
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
260129
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106788
—
AZ
Enumeration date
09/14/2021
Last updated
02/10/2022
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