Provider Demographics
NPI:1689320368
Name:BUNNELL, CHARITY D (ARNP)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:D
Last Name:BUNNELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 KNOBVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON JUNCTION
Mailing Address - State:KY
Mailing Address - Zip Code:40150-8404
Mailing Address - Country:US
Mailing Address - Phone:502-523-4326
Mailing Address - Fax:
Practice Address - Street 1:2645 LEITCHFIELD RD STE 104
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7349
Practice Address - Country:US
Practice Address - Phone:270-234-8180
Practice Address - Fax:270-234-8179
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017067363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner