Individual
JESSICA WYNNE RUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17160 WILLIAMSVILLE RD, KOSCIUSKO, MS 39090-9224
(662) 582-3677
Mailing address
17160 WILLIAMSVILLE RD, KOSCIUSKO, MS 39090-9224
(662) 582-3677
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
740464116226
—
MS
Enumeration date
12/12/2019
Last updated
12/12/2019
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