Provider Demographics
NPI:1972693513
Name:BUSHOR, PATRICIA LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:BUSHOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MCPAULEY PLACE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4733
Mailing Address - Country:US
Mailing Address - Phone:513-639-0197
Mailing Address - Fax:513-430-0314
Practice Address - Street 1:160 SAYRE DR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1945
Practice Address - Country:US
Practice Address - Phone:270-970-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4642P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710003590OtherKY MEDICAID PIN
KY00931OtherMEDICARE GROUP LPS
KY7100112650OtherMEDICAID GROUP LPS
KY00931OtherMEDICARE GROUP LPS
KY710003590OtherKY MEDICAID PIN
KYNP00110Medicare PIN