Provider Demographics
NPI:1366802928
Name:BUSH, LINDSEY DENEE' (FNP-BC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:DENEE'
Last Name:BUSH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TRACY WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1257
Mailing Address - Country:US
Mailing Address - Phone:304-343-4583
Mailing Address - Fax:304-343-9207
Practice Address - Street 1:705 WASHINGTON ST # A
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1729
Practice Address - Country:US
Practice Address - Phone:304-868-6000
Practice Address - Fax:304-868-6002
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN78664-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily