Healthcare Provider Details

I. General information

NPI: 1679687032
Provider Name (Legal Business Name): KRISTEN JILL BUSH APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1020 HIGHLAND LAKE CIR
DECATUR GA
30033-3457
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5770
  • Fax: 404-712-0116
Mailing address:
  • Phone: 678-485-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN157265 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: