Healthcare Provider Details

I. General information

NPI: 1417887183
Provider Name (Legal Business Name): THOMAS EDWARD BUSIC PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 WORCHESTER AVE
MIDDLESBORO KY
40965-2165
US

IV. Provider business mailing address

702 WORCHESTER AVE
MIDDLESBORO KY
40965-2165
US

V. Phone/Fax

Practice location:
  • Phone: 606-269-3976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4058361
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: