Provider Demographics
NPI:1750968707
Name:RUSK, CHARLEE RENE (NP-C)
Entity type:Individual
Prefix:
First Name:CHARLEE
Middle Name:RENE
Last Name:RUSK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 COUNTY ROAD 380
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-8243
Mailing Address - Country:US
Mailing Address - Phone:256-200-6223
Mailing Address - Fax:
Practice Address - Street 1:1302 S BROAD ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2605
Practice Address - Country:US
Practice Address - Phone:256-218-4080
Practice Address - Fax:256-218-4080
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166802163WE0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency