Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R875526 | MS |
NPI | 1023417938 |
---|---|
Provider Name | Mrs. Carla Ann Rushing |
First Address | Vancleave, MS 39565 |
Second Address | Gulfport, MS 39501-2515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2014 |
Last Update Date | 15/08/2014 |