Provider Demographics
NPI:1548643380
Name:NASH, RUSHAUNDA (FNP)
Entity type:Individual
Prefix:
First Name:RUSHAUNDA
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8613 MS HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-8917
Mailing Address - Country:US
Mailing Address - Phone:662-285-9460
Mailing Address - Fax:662-282-9324
Practice Address - Street 1:8613 MS HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-8917
Practice Address - Country:US
Practice Address - Phone:662-285-9460
Practice Address - Fax:662-285-9324
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR874485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR874485OtherSTATE LICENSE
MS07928714Medicaid
MS428949YP5RMedicare PIN