Provider Demographics
NPI:1982823019
Name:KAREN BUNTIN, FNP, LTD
Entity Type:Organization
Organization Name:KAREN BUNTIN, FNP, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNTIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:928-771-8200
Mailing Address - Street 1:PO BOX 2502
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86302-2502
Mailing Address - Country:US
Mailing Address - Phone:928-771-8200
Mailing Address - Fax:928-771-1660
Practice Address - Street 1:3850 N US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8428
Practice Address - Country:US
Practice Address - Phone:928-445-5339
Practice Address - Fax:928-445-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 1119363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117998Medicare PIN