Provider Demographics
NPI:1780328799
Name:BUSH, KALETHIA (LPN, CPT, EDDA)
Entity type:Individual
Prefix:MS
First Name:KALETHIA
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:LPN, CPT, EDDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 INDUSTRIAL CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4726
Mailing Address - Country:US
Mailing Address - Phone:318-331-2150
Mailing Address - Fax:214-889-8499
Practice Address - Street 1:1606 INDUSTRIAL CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4726
Practice Address - Country:US
Practice Address - Phone:972-861-2013
Practice Address - Fax:214-889-8499
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
126800000X, 171400000X, 174H00000X
LAY4K7H8M8202K00000X
LA30002221164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No126800000XDental ProvidersDental Assistant
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology