Provider Demographics
NPI:1194285825
Name:RUSHER, KERRI
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:RUSHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 GREENAN DR
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-3328
Mailing Address - Country:US
Mailing Address - Phone:918-261-2361
Mailing Address - Fax:
Practice Address - Street 1:4157 S HARVARD AVE STE 109
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2606
Practice Address - Country:US
Practice Address - Phone:918-749-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2397133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered