Healthcare Provider Details

I. General information

NPI: 1134522469
Provider Name (Legal Business Name): ANGELA R RUSH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WELLNESS WAY
COLUMBIA KY
42728-1123
US

IV. Provider business mailing address

901 WELLNESS WAY
COLUMBIA KY
42728-1123
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-7502
  • Fax: 270-384-0085
Mailing address:
  • Phone: 270-384-7502
  • Fax: 270-384-0085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008972
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: