Provider Demographics
NPI:1740731660
Name:BUNN, HOLLY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:BUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, CNS
Mailing Address - Street 1:41 HARDING DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5704
Mailing Address - Country:US
Mailing Address - Phone:501-230-5688
Mailing Address - Fax:
Practice Address - Street 1:41 HARDING DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5704
Practice Address - Country:US
Practice Address - Phone:501-230-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS002309364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health