| Doctor Name: | TAMMY LYNN BUSHONG |
| NPI Number: | 1255791182 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 53-77134-121 |
| Business Practice Address: | 102 Cline Rd Coffeyville, KS - 673373022 |
| Business Phone Number: | 6202526989 |
| Business Fax Number: | 6202513691 |
| Mailing Address: | 3011 N Michigan St, PITTSBURG |
| State: | KS |
| Postal Code: | 667622546 |
| Phone Number: | 6202319873 |
| Fax Number: | 6202315062 |
| NPI Enumeration Date: | 03/04/2016 |
| NPI Last Update Date: | 03/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 53-77134-121 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |