Provider Demographics
NPI:1043079635
Name:BUSH, KENA NORENE (COMMUNITY HEALTH WOR)
Entity Type:Individual
Prefix:
First Name:KENA
Middle Name:NORENE
Last Name:BUSH
Suffix:
Gender:F
Credentials:COMMUNITY HEALTH WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 GRANGER ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020-2419
Mailing Address - Country:US
Mailing Address - Phone:183-223-3808
Mailing Address - Fax:
Practice Address - Street 1:1908 GRANGER ST APT 4
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-2419
Practice Address - Country:US
Practice Address - Phone:183-223-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1175-0313175T00000X
TX13146172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist