Healthcare Provider Details

I. General information

NPI: 1912539362
Provider Name (Legal Business Name): SUSAN RUSHING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3654B NEW HOPE RD
COLUMBUS MS
39702-8521
US

IV. Provider business mailing address

3600 BLUECUTT RD STE 1
COLUMBUS MS
39705-1303
US

V. Phone/Fax

Practice location:
  • Phone: 662-329-1488
  • Fax:
Mailing address:
  • Phone: 662-570-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903805
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: