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Individual
KELLY S VANBUSSUM
Active
Individual
KELLY S VANBUSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3006647
KY
363L00000X
Nurse Practitioner
6647P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100149050
—
KY
Enumeration date
10/01/2010
Last updated
02/25/2019
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