MEDICARE: CATHERINE ANN KUSH DNP, GNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209005777	MO

General Provider Information

NPI Number	:	1205929338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ANN KUSH DNP, GNP-BC

Provider Business Mailing Address
First Line	:	11361 BRIERHALL CIR
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-5002
Country	:	US
Telephone Number	:	314-753-6714
Fax Number	:

Provider Business Practice Location Address
First Line	:	11361 BRIERHALL CIR
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-5002
Country	:	US
Telephone Number	:	314-753-6714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/28/2015

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