Healthcare Provider Details

I. General information

NPI: 1164326617
Provider Name (Legal Business Name): KATELYN MARIE BUNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 S HIGHWAY 27
SOMERSET KY
42501-6191
US

IV. Provider business mailing address

4341 S HIGHWAY 27
SOMERSET KY
42501-6191
US

V. Phone/Fax

Practice location:
  • Phone: 606-772-1030
  • Fax:
Mailing address:
  • Phone: 606-772-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: