Provider Demographics
NPI:1215913074
Name:RUSHING, CYNTHIA J (CFNP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:J
Last Name:RUSHING
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 HWY 351 S
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-6901
Mailing Address - Country:US
Mailing Address - Phone:662-963-9154
Mailing Address - Fax:662-963-9157
Practice Address - Street 1:4929 HWY 351 S
Practice Address - Street 2:
Practice Address - City:NETTLETON
Practice Address - State:MS
Practice Address - Zip Code:38858
Practice Address - Country:US
Practice Address - Phone:662-963-9154
Practice Address - Fax:662-963-9157
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR698164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123454Medicaid
MS500002126OtherMEDICARE
P59229Medicare UPIN
MS00123454Medicaid