MEDICARE: KEVIN RYAN RUSHIN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA12610	TX

General Provider Information

NPI Number	:	1215405279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN RYAN RUSHIN PA-C

Provider Business Mailing Address
First Line	:	6700 DALLAS PKWY STE 100
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-4323
Country	:	US
Telephone Number	:	469-850-0680
Fax Number	:	469-850-0681

Provider Business Practice Location Address
First Line	:	6700 DALLAS PKWY STE 100
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-4323
Country	:	US
Telephone Number	:	469-850-0680
Fax Number	:	469-850-0681

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	06/12/2026

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