Provider Demographics
NPI:1487617429
Name:BUSHMIAER, MARTHA KAY (APN)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:KAY
Last Name:BUSHMIAER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S MCKINLEY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5202
Mailing Address - Country:US
Mailing Address - Phone:501-666-2824
Mailing Address - Fax:501-666-9653
Practice Address - Street 1:600 S MCKINLEY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5202
Practice Address - Country:US
Practice Address - Phone:501-666-2824
Practice Address - Fax:501-666-9653
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS01059364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T887OtherARKANSAS BLUE CROSS BLUE SHEILD
AR5T887C207OtherMEDICARE
ARS54279Medicare UPIN
AR5T887C207OtherMEDICARE