Healthcare Provider Details

I. General information

NPI: 1710410774
Provider Name (Legal Business Name): AMBER NICOLE BUSHNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER NICOLE PARSONEAULT M.D.

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 SARATOGA BLVD
CORPUS CHRISTI TX
78414-4100
US

IV. Provider business mailing address

6114 SAN RAMON DR
CORPUS CHRISTI TX
78413-2919
US

V. Phone/Fax

Practice location:
  • Phone: 361-985-5811
  • Fax:
Mailing address:
  • Phone: 469-363-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR9832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: