Provider Demographics
NPI:1881999043
Name:BUNTIN, AMBER JO (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:JO
Last Name:BUNTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:JO
Other - Last Name:BOBBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19727 STALLION DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2139
Mailing Address - Country:US
Mailing Address - Phone:731-695-7001
Mailing Address - Fax:
Practice Address - Street 1:10029 CELTIC ASH DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6730
Practice Address - Country:US
Practice Address - Phone:731-695-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant