MEDICARE: JENNIFER BUNGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	4861	TN
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1083240162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BUNGE

Provider Business Mailing Address
First Line	:	856 CHERRY BLOSSOM LN
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-6239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	856 CHERRY BLOSSOM LN
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-6239
Country	:	US
Telephone Number	:	630-608-9938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	01/13/2026

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Directions to “ JENNIFER BUNGE ” Practice Location

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