Provider Demographics
NPI:1891336178
Name:BUNCHER, CASEY LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNN
Last Name:BUNCHER
Suffix:
Gender:F
Credentials:FNP-C
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 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:636-649-3085
Mailing Address - Fax:636-649-3086
Practice Address - Street 1:1935 PRAIRIE DELL RD STE 400
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-4327
Practice Address - Country:US
Practice Address - Phone:636-649-3085
Practice Address - Fax:636-649-3086
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019018815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily