MEDICARE: MRS. EMILY R BUNN PA-C

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	2129	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00696498	OTHER	VA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225180086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY R BUNN PA-C

Provider Business Mailing Address
First Line	:	1705 W MAIN ST
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-4889
Country	:	US
Telephone Number	:	615-938-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 W MAIN ST
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-4889
Country	:	US
Telephone Number	:	615-938-7171
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	02/12/2026

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