Provider Demographics
NPI:1689380388
Name:BUNKER, COURTNEY ANN (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:BUNKER
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GRACE WOOD LN
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-1797
Mailing Address - Country:US
Mailing Address - Phone:806-240-1575
Mailing Address - Fax:
Practice Address - Street 1:19 GRACE WOOD LN
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-1797
Practice Address - Country:US
Practice Address - Phone:806-240-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88086133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered