Healthcare Provider Details

I. General information

NPI: 1306348701
Provider Name (Legal Business Name): CHRISTY POPE BUSH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 HOFFMAN RD STE A
GASTONIA NC
28054-6557
US

IV. Provider business mailing address

PO BOX 531797
ATLANTA GA
30353-1797
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-1749
  • Fax: 704-865-7328
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number251231
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: