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General NPI Number Information
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NPI Number | 1619638962
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Entity Type | Individual
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Provider Name | KRISTINA BUSSEY NP
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Gender | Female
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 1405 COWART ST
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City | CHATTANOOGA
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State | TN
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Zip | 37408-1176
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Country | US
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Telephone | 423-266-3331
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 ALABAMA AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37409-1619
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Country | US
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Telephone | 423-413-6353
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 30289
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License Number State | TN
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