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NPI Code Detail

MEDICARE: MS. KELLY OTISHA BUSH NP

MEDICARE: MS. KELLY OTISHA BUSH NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN148840GA

General Provider Information

NPI Number : 1619380250
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY OTISHA BUSH NP
Provider Business Mailing Address
First Line : 2620 ELM HILL PIKE
Second Line :
City : NASHVILLE
State : TN
Zip : 37214-3108
Country : US
Telephone Number : 615-425-4200
Fax Number :
Provider Business Practice Location Address
First Line : 3240 S COBB DR SE
Second Line :
City : SMYRNA
State : GA
Zip : 30080-4194
Country : US
Telephone Number : 770-433-3477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2014
Last Update Date : 06/10/2014

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