Individual
KELLI ELIZABETH BUNTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2991 HIGHWAY K, O FALLON, MO 63368-7862
(636) 435-2333
(314) 626-8009
Mailing address
2991 HIGHWAY K, O FALLON, MO 63368-7862
(636) 435-2333
(314) 626-8009
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
149260
MO
363LF0000X
Family Nurse Practitioner
Primary
2022015784
MO
Other
Enumeration date
11/09/2021
Last updated
12/13/2022
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