Individual
KATIE M BUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 962-2000
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28150966A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71003317A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000849529
ANTHEM PTAN
IN
01
—
1225359193
ANTHEM PTAN
IN
05
—
201098700
—
IN
Enumeration date
06/15/2010
Last updated
02/10/2025
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