Healthcare Provider Details

I. General information

NPI: 1205441979
Provider Name (Legal Business Name): ANDREW PAUL BUNDT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 W OXFORD LOOP
OXFORD MS
38655-5723
US

IV. Provider business mailing address

589 NORTHWOODS DR
GRENADA MS
38901-8284
US

V. Phone/Fax

Practice location:
  • Phone: 662-550-4299
  • Fax: 662-580-4324
Mailing address:
  • Phone: 228-596-9234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number887970
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number887970
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3-002810
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: