Forrest Kenton Busch, D.O. P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

DO0000000839 Issued in TN

Legal business name

FORREST KENTON BUSCH, D.O. P.C.

Doing business as

Dyersburg Skin Clinic

Practice address

1950 Cook St
Dyersburg, TN 38024

Phone

(731) 286-4300

Fax

(731) 286-8008

NPI assigned

Jun 7, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Denise Ann Horner

Title

Office Manager

Phone

(731) 286-4300

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Dyersburg Skin Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Forrest K Busch Jr., DO

  • Dermatology Physician
  • Dyersburg, TN
  • NPI 1063425791

  Allergy & Immunology

  Medicare reassignment Care Compare group NPD
• Vonda Leeann Davis, FNP

  • Family Nurse Practitioner
  • Dyersburg, TN
  • NPI 1306990262
  Medicare reassignment Care Compare group NPD
• Kimberly Fawver, PA-C

  • Physician Assistant
  • Dyersburg, TN
  • NPI 1598808545
  Medicare reassignment Care Compare group
• Mary Beth Parks, APRN

  • Family Nurse Practitioner
  • Fort Myers, FL
  • NPI 1790735736
  NPD (past)

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441843200000",
    "number": "1740483692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 COOK ST",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "38024",
            "telephone_number": "731-286-4300",
            "fax_number": "731-286-8008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 COOK ST",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "38024",
            "telephone_number": "731-286-4300",
            "fax_number": "731-286-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORREST KENTON BUSCH, D.O. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2015-09-10",
        "status": "A",
        "authorized_official_last_name": "HORNER",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "731-286-4300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": "TN",
            "license": "DO0000000839",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TN",
            "license": "DO0000000839",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "TN",
            "license": "DO0000000839",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3303355",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dyersburg Skin Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• First Choice Medical Care PLLC
• Malissa Carnell Flagg, D.C.
• Timothy Flatman
• Forked Deer River Inpatient Services, PLLC
• Forrest K Busch DO
• Sandra Jean Fowlkes, APNFNP
• Fresenius Medical Care Dyersburg, LLC
• Julia Frye, NP
• Ashley Michelle Fuller, PHARM.D.
• G. S. Bindra, M.D., PLLC

• Dermatology Physician in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• Dermatology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.