Provider Demographics
NPI:1447569140
Name:BUSHONG, DENISE NOEL (APRN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:NOEL
Last Name:BUSHONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:NOEL
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:3151 LEITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2115
Practice Address - Country:US
Practice Address - Phone:270-685-1260
Practice Address - Fax:270-685-1284
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006592363LF0000X, 363LF0000X
KY6592P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000697003OtherANTHEM - NMA
KY123075OtherSIHO - NMA
KY50031970OtherPASSPORT & PASSPORT ADVTG - NMA
KY7100152260Medicaid
KYP00925545OtherRAILROAD MEDICARE KY - NMA
IN201019490Medicaid
KY000057094ZOtherHUMANA - NMA
KYPENDINGMedicare PIN
KY000057094ZOtherHUMANA - NMA
IN201019490Medicaid