Provider Demographics
NPI:1356013403
Name:BUSH, CANDY LYNN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CANDY
Middle Name:LYNN
Last Name:BUSH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 BRICK CHURCH CIR
Mailing Address - Street 2:
Mailing Address - City:CASTLEWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24224-5879
Mailing Address - Country:US
Mailing Address - Phone:276-698-8738
Mailing Address - Fax:
Practice Address - Street 1:142 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4636
Practice Address - Country:US
Practice Address - Phone:276-889-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily