Provider Demographics
NPI:1215405279
Name:RUSHIN, KEVIN RYAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RYAN
Last Name:RUSHIN
Suffix:
Gender:M
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 1:1301 SUMMER LEE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5452
Mailing Address - Country:US
Mailing Address - Phone:972-771-8111
Mailing Address - Fax:
Practice Address - Street 1:1301 SUMMER LEE DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5452
Practice Address - Country:US
Practice Address - Phone:972-771-8111
Practice Address - Fax:972-771-8103
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant