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General NPI Number Information
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NPI Number | 1306331558
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Entity Type | Individual
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Provider Name | KELLY CHRISTINE BUSCHE PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 800 S LOGAN BLVD STE 1200
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City | HOLLIDAYSBURG
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State | PA
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Zip | 16648-3051
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Country | US
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Telephone | 814-946-7568
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Fax | 814-943-7490
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Provider Business Mailing Address
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Address Line | 5635 E PLEASANT VALLEY BLVD
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City | TYRONE
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State | PA
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Zip | 16686-8569
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Country | US
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Telephone | 814-330-5851
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA059833
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA004496
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License Number State | PA
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