Provider Demographics
NPI:1811976731
Name:BUNTING, NANCY ANN (PHD)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:BUNTING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 TEAL POINT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653
Mailing Address - Country:US
Mailing Address - Phone:870-425-3225
Mailing Address - Fax:870-425-3225
Practice Address - Street 1:103 S MAIN
Practice Address - Street 2:STE 9
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:870-425-3225
Practice Address - Fax:870-425-3225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR028P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R76172Medicare UPIN
AR5X038Medicare ID - Type Unspecified