Provider Demographics
NPI:1336669571
Name:BUSSEY, KATHY ANN (RN, BS, PHN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:RN, BS, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10236 S 4090 RD
Mailing Address - Street 2:
Mailing Address - City:OOLOGAH
Mailing Address - State:OK
Mailing Address - Zip Code:74053-6262
Mailing Address - Country:US
Mailing Address - Phone:918-273-7500
Mailing Address - Fax:918-273-0194
Practice Address - Street 1:1020 LENAPE DR
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-4403
Practice Address - Country:US
Practice Address - Phone:918-273-7500
Practice Address - Fax:918-273-0194
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0028274163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health