Basic Information
| Provider Information | |||||||||
| NPI: | 1962585661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSH | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MSN RN CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4235 FORT CAMPBELL BLVD | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422409339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708858445 | ||||||||
| FaxNumber: | 2708869106 | ||||||||
| Practice Location | |||||||||
| Address1: | 4235 FORT CAMPBELL BLVD | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422409339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708858445 | ||||||||
| FaxNumber: | 2708869106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 12289 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.