Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kenneth Wayne Bush, PA

Individual provider Physician Assistant · NPI 1528020682

Kenneth Wayne Bush, PA is a Physician Assistant in Clemmons, North Carolina. Qualified in 2004, 22 years ago. Practices with Carolina Medicorp Enterprises LLC, a 185-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
22
Licensed in
NC
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

2311 Lewisville Clemmons Rd
Clemmons, NC 27012-8905
Phone: (336) 716-2255
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 103038 (NC)

Record details

NPI number1528020682
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedApril 4, 2006
Last updated in NPPESJune 23, 2025
Certification dateJune 23, 2025
Mailing addressPo Box 602658, Charlotte, NC 28260-2658

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Carolina Medicorp Enterprises Llc — 185 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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