1447569140 NPI number — DENISE NOEL BUSHONG APRN

Table of content: DENISE NOEL BUSHONG APRN (NPI 1447569140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447569140 NPI number — DENISE NOEL BUSHONG APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSHONG
Provider First Name:
DENISE
Provider Middle Name:
NOEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DENTON
Provider Other First Name:
DENISE
Provider Other Middle Name:
NOEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447569140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42304-3229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-688-1330
Provider Business Mailing Address Fax Number:
270-688-1338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3151 LEITCHFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-685-1260
Provider Business Practice Location Address Fax Number:
270-685-1284
Provider Enumeration Date:
09/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3006592 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000697003 . This is a "ANTHEM - NMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 123075 . This is a "SIHO - NMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50031970 . This is a "PASSPORT & PASSPORT ADVTG - NMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100152260 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00925545 . This is a "RAILROAD MEDICARE KY - NMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 201019490 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000057094Z . This is a "HUMANA - NMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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