Provider Demographics
NPI:1972960193
Name:RUSHING, KAYLA (CST)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:RUSHING
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S BIRKEY ST
Mailing Address - Street 2:
Mailing Address - City:GOODFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61742-9631
Mailing Address - Country:US
Mailing Address - Phone:309-339-0432
Mailing Address - Fax:
Practice Address - Street 1:101 S BIRKEY ST
Practice Address - Street 2:
Practice Address - City:GOODFIELD
Practice Address - State:IL
Practice Address - Zip Code:61742-9631
Practice Address - Country:US
Practice Address - Phone:309-339-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist