Provider Demographics
NPI:1699863456
Name:MONTY, LINDA RUSHING (CFNP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:RUSHING
Last Name:MONTY
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 1:731 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646-2206
Mailing Address - Country:US
Mailing Address - Phone:601-466-6664
Mailing Address - Fax:
Practice Address - Street 1:401 E LEE ST
Practice Address - Street 2:
Practice Address - City:SARDIS
Practice Address - State:MS
Practice Address - Zip Code:38666-1227
Practice Address - Country:US
Practice Address - Phone:662-487-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR656658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119289Medicaid
MS00119289Medicaid
MS302I500560Medicare Oscar/Certification