Provider Demographics
NPI:1619437027
Name:BUSBY, KATISHA
Entity Type:Individual
Prefix:
First Name:KATISHA
Middle Name:
Last Name:BUSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 BUSBY RD
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:TN
Mailing Address - Zip Code:38469-3226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:198 BUSBY RD
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:TN
Practice Address - Zip Code:38469-3226
Practice Address - Country:US
Practice Address - Phone:931-242-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer