Healthcare Provider Details

I. General information

NPI: 1689506305
Provider Name (Legal Business Name): ASHLEE BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MAGNOLIA FARMS DR
LUCEDALE MS
39452-1200
US

IV. Provider business mailing address

120 MAGNOLIA FARMS DR
LUCEDALE MS
39452-1200
US

V. Phone/Fax

Practice location:
  • Phone: 228-761-6734
  • Fax:
Mailing address:
  • Phone: 228-761-6734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number00121533
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: