Provider Demographics
NPI:1356591952
Name:RUSH, AMANDA IRENE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:IRENE
Last Name:RUSH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4589 KENNY RD STE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2770
Mailing Address - Country:US
Mailing Address - Phone:614-859-2288
Mailing Address - Fax:614-750-1515
Practice Address - Street 1:4589 KENNY RD STE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2770
Practice Address - Country:US
Practice Address - Phone:614-859-2288
Practice Address - Fax:614-750-1515
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10262363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2917802Medicaid
RUNP28091Medicare PIN