Provider Demographics
NPI:1437640158
Name:BUSH, KELLY NICOLE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:BUSH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 KIRBY DR STE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3926
Mailing Address - Country:US
Mailing Address - Phone:713-798-4491
Mailing Address - Fax:
Practice Address - Street 1:3701 KIRBY DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3921
Practice Address - Country:US
Practice Address - Phone:713-798-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH385745163WC1600X, 163WE0003X
WV90590363LF0000X
TX1118812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WE0003XNursing Service ProvidersRegistered NurseEmergency