Provider Demographics
NPI:1871382051
Name:BLUSH MEDICAL AESTHETICS & WELLNESS
Entity type:Organization
Organization Name:BLUSH MEDICAL AESTHETICS & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-515-0016
Mailing Address - Street 1:940 CHURCH RD W STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9611
Mailing Address - Country:US
Mailing Address - Phone:662-515-0016
Mailing Address - Fax:
Practice Address - Street 1:940 CHURCH RD W STE B
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9611
Practice Address - Country:US
Practice Address - Phone:662-515-0016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care