Provider Demographics
NPI:1962553156
Name:BUSHEY CALLEY, CATHERINE M (NP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:BUSHEY CALLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 TOM MILLER RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6427
Mailing Address - Country:US
Mailing Address - Phone:518-324-7246
Mailing Address - Fax:518-324-3366
Practice Address - Street 1:294 TOM MILLER RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6427
Practice Address - Country:US
Practice Address - Phone:518-324-7246
Practice Address - Fax:518-324-3366
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300427-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02433241Medicaid
NY000490094001OtherBSNENY
NYP00076782OtherRAILROAD MEDICARE
NY02433241Medicaid
R51510Medicare UPIN