Provider Demographics
NPI:1396981049
Name:BUSBOOM, KARLA ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:ELAINE
Last Name:BUSBOOM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:ELAINE
Other - Last Name:CROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:13616 CALIFORNIA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5336
Mailing Address - Country:US
Mailing Address - Phone:402-496-5517
Mailing Address - Fax:402-496-0517
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:STE 124
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:785-843-6973
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200597400AMedicaid
KS004234005Medicare PIN