Individual
PATRICIA LYNN BUSHOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
160 SAYRE DR, MAYFIELD, KY 42066-1945
(270) 970-0397
Mailing address
4600 MCPAULEY PLACE, CINCINNATI, OH 45242-4733
(513) 639-0197
(513) 430-0314
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4642P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00931
MEDICARE GROUP LPS
KY
01
—
710003590
KY MEDICAID PIN
KY
01
—
7100112650
MEDICAID GROUP LPS
KY
Enumeration date
10/13/2006
Last updated
03/16/2011
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