Provider Demographics
NPI:1073115697
Name:RUSH, KARLEIGH M (PA-C)
Entity Type:Individual
Prefix:
First Name:KARLEIGH
Middle Name:M
Last Name:RUSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2221
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2221
Mailing Address - Country:US
Mailing Address - Phone:616-328-9791
Mailing Address - Fax:
Practice Address - Street 1:4389 BEAUFORT RD
Practice Address - Street 2:
Practice Address - City:CHERRY POINT
Practice Address - State:NC
Practice Address - Zip Code:28533
Practice Address - Country:US
Practice Address - Phone:252-466-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC001010873363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program