Provider Demographics
NPI:1225180086
Name:BUNN, EMILY R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:R
Last Name:BUNN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY PARK DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3956
Mailing Address - Country:US
Mailing Address - Phone:615-966-6304
Mailing Address - Fax:
Practice Address - Street 1:3500 N MOUNT JULIET RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3059
Practice Address - Country:US
Practice Address - Phone:615-758-5672
Practice Address - Fax:615-758-5609
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00696498OtherMEDICARE RAILROAD
VA1225180086Medicaid
VA1225180086Medicaid
012865C63Medicare PIN
VAVV1170AMedicare PIN
012866C87Medicare PIN
012864C86Medicare PIN
VA00X967C01Medicare PIN
VA017977C18Medicare PIN