Healthcare Provider Details

I. General information

NPI: 1912862038
Provider Name (Legal Business Name): REAGAN M RUSHING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE STE 260
MEMPHIS TN
38104-7549
US

IV. Provider business mailing address

513 W OLIVER AVE
WEST MEMPHIS AR
72301-2925
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-6051
  • Fax:
Mailing address:
  • Phone: 870-514-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: