Provider Demographics
NPI:1932201845
Name:BUSHONG, KATHERINE LEE (RN, ARNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEE
Last Name:BUSHONG
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1758
Mailing Address - Country:US
Mailing Address - Phone:513-961-4700
Mailing Address - Fax:513-961-1912
Practice Address - Street 1:320 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3410
Practice Address - Country:US
Practice Address - Phone:859-341-4266
Practice Address - Fax:859-341-9532
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2635P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78007119Medicaid
000000194047OtherANTHEM
S62402Medicare UPIN
KY0306032Medicare ID - Type Unspecified