Provider Demographics
NPI:1073245262
Name:RUSH, KALLI ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:KALLI
Middle Name:ANN
Last Name:RUSH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 S WASHINGTON ST STE 270
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4193
Mailing Address - Country:US
Mailing Address - Phone:402-291-3123
Mailing Address - Fax:
Practice Address - Street 1:1413 S WASHINGTON ST STE 270
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4193
Practice Address - Country:US
Practice Address - Phone:402-291-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE412213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty