Provider Demographics
NPI:1386161594
Name:BUNKLEY, SHERESE LATASHA (FNP)
Entity type:Individual
Prefix:
First Name:SHERESE
Middle Name:LATASHA
Last Name:BUNKLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-483-7113
Mailing Address - Fax:757-483-7151
Practice Address - Street 1:3060 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8274
Practice Address - Country:US
Practice Address - Phone:757-923-9660
Practice Address - Fax:757-923-9665
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily