Provider Demographics
NPI:1922195445
Name:BUNCH, SHERRI (ARNP)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:BUNCH
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 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-465-2605
Mailing Address - Fax:270-234-8572
Practice Address - Street 1:1013 GRANITE DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2013
Practice Address - Country:US
Practice Address - Phone:502-349-3100
Practice Address - Fax:502-349-3169
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4972P363L00000X
KY3004972363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30605018Medicaid
KY000000491440OtherANTHEM
KY0762348Medicare PIN
KY0763548Medicare PIN
KY0974721Medicare PIN
KY00201008Medicare PIN
KY00206006Medicare PIN
KY00207006Medicare PIN
KY00200008Medicare PIN
KY00205006Medicare PIN
KY0762252Medicare PIN
KY000000491440OtherANTHEM
KY00199008Medicare PIN