Provider Demographics
NPI:1306662184
Name:RUSH, KRISTEN ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:RUSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15300 WEST AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4685
Mailing Address - Country:US
Mailing Address - Phone:708-226-2318
Mailing Address - Fax:708-226-2319
Practice Address - Street 1:15300 WEST AVE STE 108
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4685
Practice Address - Country:US
Practice Address - Phone:708-226-2318
Practice Address - Fax:708-226-2319
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2025-02-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical