Provider Demographics
NPI:1730359613
Name:BUNNER, KYLIE MARIE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:MARIE
Last Name:BUNNER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 PARK SPRINGS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-4729
Mailing Address - Country:US
Mailing Address - Phone:817-467-7474
Mailing Address - Fax:
Practice Address - Street 1:202 S COLEMAN ST STE 100
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2740
Practice Address - Country:US
Practice Address - Phone:817-467-7474
Practice Address - Fax:817-468-8643
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX719943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283585203Medicaid
TX283585201Medicaid
TX283585201Medicaid
TXTXB133055Medicare PIN
TXTXB133057Medicare PIN