Kelly A. Bush, L.I.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

077404 Issued in IA

Practice address

1811 Pineacre Ave
Davenport, IA 52803-3555

Phone

(563) 528-9191

NPI assigned

Dec 24, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640304000000",
    "number": "1649930173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 PINEACRE AVE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528033555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 PINEACRE AVE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528033555",
            "telephone_number": "563-528-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "KELLY",
        "middle_name": "A.",
        "credential": "L.I.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-24",
        "last_updated": "2021-12-24",
        "certification_date": "2021-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "077404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Lynn Burnett, PHAR M D
• Melanie Dawn Burns, PA-C
• Stephanie D Burnside
• Felicia S. Burrell, LPN
• Jenna M Bush, DPT
• Sarah A Butcher, CRNA
• Butterfly Beginnings Counseling LLC
• Francesca Ann Byczynski, MS, BCBA
• Jena J Byorum, LISW
• Kellie Byrd, PHARMD

• All providers in Davenport, IA
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.