Provider Demographics
NPI:1154695229
Name:BUNTSIS-THOMAS, YANA (APRN)
Entity type:Individual
Prefix:MRS
First Name:YANA
Middle Name:
Last Name:BUNTSIS-THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:YANA
Other - Middle Name:
Other - Last Name:BUNTSIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3299
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-3299
Mailing Address - Country:US
Mailing Address - Phone:775-222-0044
Mailing Address - Fax:888-700-0187
Practice Address - Street 1:828 LANE ALLEN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:502-498-4071
Practice Address - Fax:888-423-5216
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004759363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100394020Medicaid
KYK181211Medicare PIN