Provider Demographics
NPI: | 1619672193 |
---|---|
Name: | RUSK, ASHLEE ANN (APRN, FNP-C) |
Entity Type: | Individual |
Prefix: | |
First Name: | ASHLEE |
Middle Name: | ANN |
Last Name: | RUSK |
Suffix: | |
Gender: | F |
Credentials: | APRN, 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: | 2599 COUNTY ROAD 724 |
Mailing Address - Street 2: | |
Mailing Address - City: | NACOGDOCHES |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75964-2556 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 936-554-9189 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1806 HUMBLE PLACE DR |
Practice Address - Street 2: | |
Practice Address - City: | HUMBLE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77338-5277 |
Practice Address - Country: | US |
Practice Address - Phone: | 281-369-9514 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2023-04-03 |
Last Update Date: | 2023-04-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 1113744 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
F02230790 | Other | AMERICAN ACADEMY OF NURSE PRACTITIONERS - CERTIFICATION | |
TX | 1113744 | Other | BOARD OF NURSING APRN LICENSE |
TX | 48005 | Other | PRESCRIPTIVE AUTHORITY NUMBER |