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General NPI Number Information
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NPI Number | 1043079635
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Entity Type | Individual
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Provider Name | KENA NORENE BUSH COMMUNITY HEALTH WOR
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Gender | Female
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 1908 GRANGER ST APT 4
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City | HOUSTON
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State | TX
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Zip | 77020-2419
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Country | US
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Telephone | 183-223-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 1908 GRANGER ST APT 4
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City | HOUSTON
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State | TX
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Zip | 77020-2419
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Country | US
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Telephone | 183-223-3808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 1175-0313
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 13146
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License Number State | TX
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