Provider Demographics
NPI:1619672193
Name:RUSK, ASHLEE ANN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:ANN
Last Name:RUSK
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 COUNTY ROAD 724
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-2556
Mailing Address - Country:US
Mailing Address - Phone:936-554-9189
Mailing Address - Fax:
Practice Address - Street 1:1806 HUMBLE PLACE DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5277
Practice Address - Country:US
Practice Address - Phone:281-369-9514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F02230790OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS - CERTIFICATION
TX1113744OtherBOARD OF NURSING APRN LICENSE
TX48005OtherPRESCRIPTIVE AUTHORITY NUMBER