Provider Demographics
NPI:1619558251
Name:RUSHING, KRISTIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:RUSHING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LAKE FORGETFUL APT 823
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8636
Mailing Address - Country:US
Mailing Address - Phone:228-239-8210
Mailing Address - Fax:
Practice Address - Street 1:1130 FRONTAGE DR W
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-8165
Practice Address - Country:US
Practice Address - Phone:601-716-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner