Healthcare Provider Details

I. General information

NPI: 1215913074
Provider Name (Legal Business Name): CYNTHIA J RUSHING CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 HWY 351 S
NETTLETON MS
38858
US

IV. Provider business mailing address

4929 HWY 351 S
NETTLETON MS
38858-6901
US

V. Phone/Fax

Practice location:
  • Phone: 662-963-9154
  • Fax: 662-963-9157
Mailing address:
  • Phone: 662-963-9154
  • Fax: 662-963-9157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR698164
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: