Healthcare Provider Details

I. General information

NPI: 1508236415
Provider Name (Legal Business Name): BETHANY CLAIRE BUSH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 HIGHWAY 80 E STE A-B
CLINTON MS
39056-4720
US

IV. Provider business mailing address

118 HOMESTEAD DR
MADISON MS
39110-6974
US

V. Phone/Fax

Practice location:
  • Phone: 601-924-4000
  • Fax:
Mailing address:
  • Phone: 601-924-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR891236
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: