Provider Demographics
NPI:1205577251
Name:RHONDA TERESE RUSHING LLC
Entity type:Organization
Organization Name:RHONDA TERESE RUSHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:TERESE
Authorized Official - Last Name:RUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:318-303-3077
Mailing Address - Street 1:130 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-7671
Mailing Address - Country:US
Mailing Address - Phone:318-235-1451
Mailing Address - Fax:
Practice Address - Street 1:1106 STUBBS AVE STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5641
Practice Address - Country:US
Practice Address - Phone:318-303-3077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2573373Medicaid