Healthcare Provider Details

I. General information

NPI: 1043334568
Provider Name (Legal Business Name): NADINE K BUSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 SIMPSON HIGHWAY 149
MENDENHALL MS
39114-3438
US

IV. Provider business mailing address

1842 SIMPSON HIGHWAY 149
MENDENHALL MS
39114-3438
US

V. Phone/Fax

Practice location:
  • Phone: 601-847-2221
  • Fax: 601-847-7104
Mailing address:
  • Phone: 601-847-2221
  • Fax: 601-847-7104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMS16456
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: