Provider Demographics
NPI:1174097018
Name:BUSH, PATRICIA ANN (APRN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:BUSH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 GILBERT AVE APT F
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7907
Mailing Address - Country:US
Mailing Address - Phone:214-449-8617
Mailing Address - Fax:
Practice Address - Street 1:6105 WINDCOM CT STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7890
Practice Address - Country:US
Practice Address - Phone:972-473-9063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139923363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP139923OtherTEXAS BOARD OF NURSING