Provider Demographics
NPI:1881087658
Name:BUSH, CHRISTOPHER
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:BUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7926 CALEDONIA CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-1469
Mailing Address - Country:US
Mailing Address - Phone:859-620-5935
Mailing Address - Fax:
Practice Address - Street 1:39 W 10TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-1444
Practice Address - Country:US
Practice Address - Phone:859-620-5935
Practice Address - Fax:317-780-5538
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18437363LF0000X
KY3011370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily