Provider Demographics
NPI:1487819637
Name:BUNN, KATHERINE G (RD LD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:G
Last Name:BUNN
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:100 MERCY WAY STE 580
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-556-8555
Mailing Address - Fax:
Practice Address - Street 1:100 MERCY WAY STE 580
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-556-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-26
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035386133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered