Provider Demographics
NPI:1164729406
Name:BUSH TAYLOR, AMESHIA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:AMESHIA
Middle Name:D
Last Name:BUSH TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-1121
Mailing Address - Country:US
Mailing Address - Phone:251-654-7453
Mailing Address - Fax:251-380-6973
Practice Address - Street 1:451 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-1121
Practice Address - Country:US
Practice Address - Phone:251-654-7453
Practice Address - Fax:251-380-6973
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1081016363L00000X, 363LC1500X, 363LP2300X, 363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1081016OtherSTATE LICENSE