Individual
KELLIE ANNE RUTHERFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5955 HARBOUR PARK DR, MIDLOTHIAN, VA 23112-2163
(804) 744-4495
Mailing address
5955 HARBOUR PARK DR, MIDLOTHIAN, VA 23112-2163
(804) 744-4495
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024176699
VA
Other
Enumeration date
10/24/2018
Last updated
08/22/2024
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