KELLY A BUSHUR (NPI# 1629248406) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629248406 |
| Entity Type | Individual |
| Full Name | KELLY A BUSHUR |
| Other Name | KELLY A RHODES |
| Credential | CP PH.D |
| Practice Address |
400 S Lewis Ln Carbondale IL 62901-3547 |
| Mailing Address |
Po Box 577 Carterville IL 62918-0577 |
| Practice Telephone | 6185199900 |
| Practice Fax Number | 6185291384 |
| Mailing Telephone | 6189858221 |
| Mailing Fax Number | 6189856860 |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2014-10-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
071005772 | IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 370966854002 | 05 | |
| IL | 370966854024 | 05 | |
| IL | MEDICARE GROUP ID | 640701 | 01 |
| IL | 370966854005 | 05 | |
| IL | 370966854006 | 05 | |
| IL | 370966854015 | 05 |
| Street Address |
400 S LEWIS LN |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-3547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356337133 | Kelly Colleen Higgins | Internal Medicine | 400 S Lewis Ln, Carbondale, IL 62901-3547 | 2005-09-27 |
| 1629629357 | Shawnee Health Service and Development Corp | Clinic/Center | 400 S Lewis Ln, Carbondale, IL 62901-3547 | 2019-09-24 |
| 1205323763 | Laboratory Corporation of America | Clinical Medical Laboratory | 400 S Lewis Ln, Carbondale, IL 62901 | 2018-04-19 |
| 1780134130 | Christina Trapp | Physician Assistant | 400 S Lewis Ln, Carbondale, IL 62901-3547 | 2016-10-10 |
| 1184095622 | Sara Hoyle | Physician Assistant | 400 S Lewis Ln, Carbondale, IL 62901-3547 | 2015-10-09 |
| 1811303977 | Lab One LLC | Clinical Medical Laboratory | 400 S Lewis Ln, Carbondale, IL 62901-3547 | 2014-07-09 |
| 1801201538 | Tasmeer Hassan | Family Medicine | 400 S Lewis Ln, Carbondale, IL 62901-3547 | 2014-06-20 |
| 1528478559 | Renee Barnes Feather | Family Medicine | 400 S Lewis Ln, Carbondale, IL 62901-3547 | 2014-04-29 |
| 1144661158 | Stacy L Agosto | Social Worker | 400 S Lewis Ln, Carbondale, IL 62901 | 2013-07-08 |
| 1053669903 | Kristi Ann Annegers | Counselor | 400 S Lewis Ln, Carbondale, IL 62901-3547 | 2012-08-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306196761 | Jean A. Cunningham | Psychologist | 231 W Main St Ste 1, Carbondale, IL 62901-2948 | 2012-09-13 |
| 1144479478 | Holly Cormier | Psychologist | 139 Pine Shore Dr, 37, Carbondale, IL 62902-7503 | 2008-09-10 |
| 1770795882 | Lori Anne Hinsley | Psychologist | Student Health Center, 374 E Grand, Carbondale, IL 62901 | 2007-05-03 |
| 1417173782 | Debra Lynn Braunling Mcmorrow | Psychologist | 306 W Mill Street, 2nd Floor, Carbondale, IL 62902 | 2007-04-17 |
| 1376661272 | James S Peterson | Psychologist | 1400 W Main, Suite 16, Carbondale, IL 62901 | 2007-03-27 |
| 1437247012 | Melinda Luanne Bloos | Psychologist | 3200 Fishback Rd, Milwood Executive Suites, Carbondale, IL 62901-6307 | 2006-10-10 |
| 1093740862 | Jeffrey Saunders Kellogg | Psychologist | 3412 S Illinois Ave, Carbondale, IL 62903-8362 | 2006-07-11 |
| 1134748635 | Warren Thomas Bush | Psychologist | 374 E Grand Ave, Carbondale, IL 62901-3962 | 2020-04-14 |
| 1700412871 | Jose Arroyo | Psychologist | 231 W Main St Ste 1, Carbondale, IL 62901-2948 | 2020-03-20 |
| 1992210975 | Alec Eshelman | Psychologist | 374 E Grand Ave, Carbondale, IL 62901-3962 | 2017-12-12 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on KELLY A BUSHUR.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.