Individual
KENNETH V BUSBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S. / B.A.
Contact information
Practice address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 525-4691
Mailing address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 522-1592
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004990
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0205798
L&I
WA
05
—
8444994
—
WA
01
—
P00290212
RAIL ROAD MEDICARE
WA
Enumeration date
02/15/2006
Last updated
11/27/2007
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