Healthcare Provider Details

I. General information

NPI: 1669382974
Provider Name (Legal Business Name): EMMA CHERI FERN BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 S DIXIE BLVD STE 1
RADCLIFF KY
40160-1296
US

IV. Provider business mailing address

29 SHALE LN
RINEYVILLE KY
40162-9631
US

V. Phone/Fax

Practice location:
  • Phone: 859-254-1035
  • Fax:
Mailing address:
  • Phone: 859-254-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: