Provider Demographics
NPI:1184261091
Name:RUSHING, KATHERINE LEONA (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEONA
Last Name:RUSHING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LEONA
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 JEROME ST STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3942
Mailing Address - Country:US
Mailing Address - Phone:817-732-6060
Mailing Address - Fax:817-731-2541
Practice Address - Street 1:3455 LOCKE AVE STE 315
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5747
Practice Address - Country:US
Practice Address - Phone:817-336-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant