Provider Demographics
NPI:1962585661
Name:BUSH, PAMELA K (MSN RN CPNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:BUSH
Suffix:
Gender:
Credentials:MSN RN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 FORT CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-9339
Mailing Address - Country:US
Mailing Address - Phone:270-885-8445
Mailing Address - Fax:270-886-9106
Practice Address - Street 1:4235 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-9339
Practice Address - Country:US
Practice Address - Phone:270-885-8445
Practice Address - Fax:270-886-9106
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12289363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
G25630Medicare UPIN