Provider Demographics
NPI:1134904113
Name:BUSH, CADTINA
Entity type:Individual
Prefix:
First Name:CADTINA
Middle Name:
Last Name:BUSH
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 1:4780 I 55 N STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5583
Mailing Address - Country:US
Mailing Address - Phone:601-277-7825
Mailing Address - Fax:601-277-7830
Practice Address - Street 1:316 M.L.K. JR ST
Practice Address - Street 2:
Practice Address - City:JONESTOWN
Practice Address - State:MS
Practice Address - Zip Code:38639
Practice Address - Country:US
Practice Address - Phone:402-975-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS926911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse