Provider Demographics
NPI:1114535911
Name:BUNCH, LEA ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:ANNE
Last Name:BUNCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 BRACKETT CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:KY
Mailing Address - Zip Code:42784-9210
Mailing Address - Country:US
Mailing Address - Phone:270-735-2574
Mailing Address - Fax:
Practice Address - Street 1:1324 WOODLAND DR STE A
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2662
Practice Address - Country:US
Practice Address - Phone:270-765-5921
Practice Address - Fax:270-982-3324
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100685330Medicaid