Provider Demographics
NPI:1730624016
Name:BUNTIN, KEVIN J (CRNA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:BUNTIN
Suffix:
Gender:M
Credentials:CRNA
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 645996
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-5996
Mailing Address - Country:US
Mailing Address - Phone:270-651-4444
Mailing Address - Fax:270-651-4229
Practice Address - Street 1:1301 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3483
Practice Address - Country:US
Practice Address - Phone:270-651-4444
Practice Address - Fax:270-651-4229
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010982367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100435290Medicaid