Provider Demographics
NPI:1073233284
Name:BUSH, SHYANN ALEXUS
Entity Type:Individual
Prefix:MRS
First Name:SHYANN
Middle Name:ALEXUS
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHYANN
Other - Middle Name:ALEXUS
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 E PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4202
Mailing Address - Country:US
Mailing Address - Phone:866-921-0149
Mailing Address - Fax:479-777-4400
Practice Address - Street 1:700 E PARKWAY DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4202
Practice Address - Country:US
Practice Address - Phone:866-921-0149
Practice Address - Fax:479-777-4400
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator