Provider Demographics
NPI:1053463042
Name:BUSS, KEVIN PAUL (MSN, CRNA)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PAUL
Last Name:BUSS
Suffix:
Gender:M
Credentials:MSN, CRNA
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Mailing Address - Street 1:736 WOODSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2121
Mailing Address - Country:US
Mailing Address - Phone:757-467-0181
Mailing Address - Fax:757-953-5012
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165439367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered