Healthcare Provider Details

I. General information

NPI: 1508408089
Provider Name (Legal Business Name): KACEY RICE BUSQUE NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST
MADISON WI
53715-1830
US

IV. Provider business mailing address

11228 N MASON DR
EDGERTON WI
53534-8554
US

V. Phone/Fax

Practice location:
  • Phone: 931-993-5073
  • Fax:
Mailing address:
  • Phone: 931-993-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number4704380497
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number14684-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number187805
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: