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General NPI Number Information
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NPI Number | 1053973321
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Entity Type | Individual
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Provider Name | TRACY ELAINE BUSH CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 1131 LEIGHTON AVE
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City | ANNISTON
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State | AL
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Zip | 36207-4610
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Country | US
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Telephone | 256-237-0025
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Fax |
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Provider Business Mailing Address
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Address Line | 6001 ENCLAVE PL
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City | TRUSSVILLE
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State | AL
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Zip | 35173-3833
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Country | US
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Telephone | 205-960-0291
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 1-091713
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1-091713
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License Number State | AL
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