Individual
AMANDA CALLOWAY RUTHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF MEDICINE, SHREVEPORT, LA 71103-4228
(318) 813-1622
(318) 675-5907
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.A10349.RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1624926
—
LA
Enumeration date
04/14/2009
Last updated
03/15/2018
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