Provider Demographics
NPI:1306331558
Name:BUSCHE, KELLY CHRISTINE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:CHRISTINE
Last Name:BUSCHE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5635 E PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-8569
Mailing Address - Country:US
Mailing Address - Phone:814-330-5851
Mailing Address - Fax:
Practice Address - Street 1:800 S LOGAN BLVD STE 1200
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-3051
Practice Address - Country:US
Practice Address - Phone:814-946-7568
Practice Address - Fax:814-943-7490
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA059833363A00000X
PAOA004496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant