Individual
KAITLIN BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
632 SLATE AVE, OWINGSVILLE, KY 40360-2206
(606) 674-6386
(606) 674-3096
Mailing address
PO BOX 1120, OWINGSVILLE, KY 40360-1120
(606) 674-6386
(606) 674-3096
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1192698
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1192698
CERTIFICATION
KY
Enumeration date
02/08/2022
Last updated
11/22/2022
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