Provider Demographics
NPI:1629431564
Name:RUSK, ANNA KRISTIN (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:KRISTIN
Last Name:RUSK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:KRISTIN
Other - Last Name:GAMWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:255 W LEBANON STE 106
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-3412
Mailing Address - Country:US
Mailing Address - Phone:469-294-0210
Mailing Address - Fax:
Practice Address - Street 1:255 W LEBANON STE 106
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-3412
Practice Address - Country:US
Practice Address - Phone:469-294-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR7212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program