Provider Demographics
NPI:1659372332
Name:BUSH, VICKIE L (CFNP)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:BUSH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:L
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-436-7280
Mailing Address - Fax:812-436-7290
Practice Address - Street 1:4498 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3622
Practice Address - Country:US
Practice Address - Phone:812-436-7280
Practice Address - Fax:812-436-7290
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001673A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200464740Medicaid
KY78011269Medicaid
P96552Medicare UPIN
INM400065019Medicare PIN