Provider Demographics
NPI:1205929338
Name:KUSH, CATHERINE ANN (DNP, GNP-BC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:KUSH
Suffix:
Gender:F
Credentials:DNP, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11361 BRIERHALL CIR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-5002
Mailing Address - Country:US
Mailing Address - Phone:314-753-6714
Mailing Address - Fax:
Practice Address - Street 1:11361 BRIERHALL CIR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-5002
Practice Address - Country:US
Practice Address - Phone:314-753-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO209005777363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
S62526Medicare UPIN
IL522000005Medicare PIN