Provider Demographics
NPI:1376255661
Name:BUSH, JOSHUA (RN)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BUSH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 MOCKINGBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7709
Mailing Address - Country:US
Mailing Address - Phone:910-616-2241
Mailing Address - Fax:866-918-4457
Practice Address - Street 1:273 MOCKINGBIRD CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7709
Practice Address - Country:US
Practice Address - Phone:910-616-2241
Practice Address - Fax:866-918-4457
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC232518163W00000X, 163WA0400X, 163WX0002X, 163WX0003X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient