Healthcare Provider Details

I. General information

NPI: 1356751069
Provider Name (Legal Business Name): JILLIAN RUSHING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 COTTONWOOD PARK NW STE C
ALBUQUERQUE NM
87114-7035
US

IV. Provider business mailing address

10301 COTTONWOOD PARK NW STE C
ALBUQUERQUE NM
87114-7035
US

V. Phone/Fax

Practice location:
  • Phone: 505-871-3863
  • Fax: 505-447-2371
Mailing address:
  • Phone: 505-871-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017-0500
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: