Basic Information
| Provider Information | |||||||||
| NPI: | 1306331558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSCHE | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5635 E PLEASANT VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | TYRONE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166868569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143305851 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 S LOGAN BLVD STE 1200 | ||||||||
| Address2: | |||||||||
| City: | HOLLIDAYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166483051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149467568 | ||||||||
| FaxNumber: | 8149437490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2018 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA059833 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | OA004496 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.