Provider Demographics
NPI:1053778787
Name:BUSH, KELLY (APN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-599-9499
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4400 BROADWAY
Practice Address - Street 2:SUITE 520
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3498
Practice Address - Country:US
Practice Address - Phone:816-531-4080
Practice Address - Fax:816-531-0281
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2016000625363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology