Provider Demographics
NPI:1265009575
Name:BUSSINEAU, CAROLYN (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BUSSINEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3540
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8QF481OtherBCBS - UNIVERSAL SURGICAL PARTNERS
TX8QC673OtherBCBS - XCITE SURGICAL
TX8QC855OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS
TXPA14707OtherTEXAS MEDICAL BOARD
TX8QA717OtherBCBS - BLUESTAR SURGICAL
TX8PX960OtherBCBS - UNIVERSAL SURGICAL MSO