Basic Information
| Provider Information | |||||||||
| NPI: | 1710119565 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSH | ||||||||
| FirstName: | MINDY | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 727 MOUNT TABOR RD STE A | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471506951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129813111 | ||||||||
| FaxNumber: | 8129813829 | ||||||||
| Practice Location | |||||||||
| Address1: | 3999 DUTCHMANS LN STE A | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023652655 | ||||||||
| FaxNumber: | 5023652770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 363LA2200X | 28160661A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 3006234 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.