Healthcare Provider Details

I. General information

NPI: 1114535911
Provider Name (Legal Business Name): LEA ANNE BUNCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 08/12/2022
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 WOODLAND DR STE A
ELIZABETHTOWN KY
42701-2662
US

IV. Provider business mailing address

761 BRACKETT CEMETERY RD
UPTON KY
42784-9210
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-5921
  • Fax: 270-982-3324
Mailing address:
  • Phone: 270-735-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014772
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: