Most Relevant Information
Provider Data
| NPI Number: | 1003454885 |
| Provider Name: | JESSICA WYNNE RUSH |
| Entity Type: | Individual |
| Taxonomy Code: | 3747A0650X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/12/2019 |
| Last Updated: | 12/12/2019 |
Provider Practice Location
17160 WILLIAMSVILLE RD
KOSCIUSKO
MS
390909224
Practice Location Phone/Fax
| Phone: | 6625823677 |
| Fax: |
Provider Mailing Location
17160 WILLIAMSVILLE RD
KOSCIUSKO
MS
390909224
Provider Mailing Phone/Fax
| Phone: | 6625823677 |
| Fax: |