Healthcare Provider Details

I. General information

NPI: 1245346949
Provider Name (Legal Business Name): JOHN MICHAEL RUSHFORTH JR. MS, RN, NPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 W HENRIETTA RD
ROCHESTER NY
14623-2327
US

IV. Provider business mailing address

79 SPARROW DR
WEST HENRIETTA NY
14586-9304
US

V. Phone/Fax

Practice location:
  • Phone: 585-279-4922
  • Fax: 585-461-9504
Mailing address:
  • Phone: 585-334-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number400518
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number436150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: