Active NPI
Jeffrey Glenn Rutter, PSY.D.
- Clinical Psychologist
- Clarksville, TN
National Provider Identifier
1306118948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3270
- Practice address
- 524 College St
Clarksville, TN 37040-3255 - Phone
- (931) 221-6162
- NPI assigned
- Jan 28, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2509 | CO | |
| Clinical Psychologist | 103TC0700X | 3270 | TN | Primary |
Addresses
Primary practice location
524 College St
Clarksville, TN 37040-3255
Mailing address
PO Box 4564
Clarksville, TN 37044-0001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3270 | TN | MD | Clinical Psychologist |
| 2509 | CO | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496188800000",
"number": "1306118948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4564",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370440001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "524 COLLEGE ST",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370403255",
"telephone_number": "931-221-6162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUTTER",
"first_name": "JEFFREY",
"middle_name": "GLENN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-28",
"last_updated": "2017-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "2509",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "3270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.