Jessica Rose Rutkoski, CRNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

SP019245 Issued in PA

Practice address

6454 Route 405 Hwy
Muncy, PA 17756-6388

Phone

(570) 546-7009

NPI assigned

Sep 12, 2018

Last updated

Aug 18, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566086400000",
    "number": "1063995421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 N 12TH ST STE 101",
            "city": "LEMOYNE",
            "state": "PA",
            "postal_code": "170431219",
            "telephone_number": "570-417-9985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6454 ROUTE 405 HWY",
            "city": "MUNCY",
            "state": "PA",
            "postal_code": "177566388",
            "telephone_number": "570-546-7009"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6454 Route 405 Hwy",
            "address_purpose": "LOCATION",
            "city": "Muncy",
            "state": "PA",
            "postal_code": "17756",
            "country_code": "US",
            "telephone_number": "570-546-7009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUTKOSKI",
        "first_name": "JESSICA",
        "middle_name": "ROSE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-12",
        "last_updated": "2019-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP019245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Muncy, PA
• Providers in Muncy, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.