Provider Demographics
NPI:1083703599
Name:RUSH, ABBY A (CRNA)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:A
Last Name:RUSH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:A
Other - Last Name:JARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:13515 BARRETT PARKWAY DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5870
Mailing Address - Country:US
Mailing Address - Phone:314-775-2816
Mailing Address - Fax:314-775-2821
Practice Address - Street 1:300 FIRST CAPITOL DR
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301
Practice Address - Country:US
Practice Address - Phone:314-821-1256
Practice Address - Fax:314-821-1239
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006028431367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO916819303Medicaid
MOP00384697OtherRR MEDICARE
MOP00384697OtherRR MEDICARE