Provider Demographics
NPI:1881022234
Name:RUSH, AMY E (PNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:RUSH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:MARIALKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:14557 HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-9582
Practice Address - Country:US
Practice Address - Phone:678-688-1580
Practice Address - Fax:678-688-1594
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18479363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics