Provider Demographics
NPI:1780986133
Name:RUSHING, LEWIS
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:
Last Name:RUSHING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HOPE LN
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-7311
Mailing Address - Country:US
Mailing Address - Phone:662-563-0700
Mailing Address - Fax:
Practice Address - Street 1:1755 KIRBY PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-8300
Practice Address - Country:US
Practice Address - Phone:901-725-5846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866393367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered