MEDICARE: KATHERINE LEONA RUSHING PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA13216	TX

General Provider Information

NPI Number	:	1184261091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE LEONA RUSHING PA-C

Provider Business Mailing Address
First Line	:	900 JEROME ST STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3942
Country	:	US
Telephone Number	:	817-732-6060
Fax Number	:	817-731-2541

Provider Business Practice Location Address
First Line	:	3455 LOCKE AVE STE 315
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5747
Country	:	US
Telephone Number	:	817-336-1189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	02/17/2022

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