Provider Demographics
NPI:1598016198
Name:BUSH, JANE ANN (APRN, CPNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:BUSH
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3007
Mailing Address - Country:US
Mailing Address - Phone:318-445-2223
Mailing Address - Fax:318-445-2573
Practice Address - Street 1:3916 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3007
Practice Address - Country:US
Practice Address - Phone:318-445-2223
Practice Address - Fax:318-445-2573
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07088363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics