Provider Demographics
NPI:1710119565
Name:BUSH, MINDY KAY (APRN)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:KAY
Last Name:BUSH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:727 MOUNT TABOR RD STE A
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6951
Mailing Address - Country:US
Mailing Address - Phone:812-981-3111
Mailing Address - Fax:812-981-3829
Practice Address - Street 1:3999 DUTCHMANS LN STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4744
Practice Address - Country:US
Practice Address - Phone:502-365-2655
Practice Address - Fax:502-365-2770
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28160661A363LA2200X
KY3006234363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health