| Doctor Name: | JEFFERSON BUNTIN |
| NPI Number: | 1114318417 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | N.P. |
| License Number: | R881222 |
| Business Practice Address: | 146 Highland Pkwy Picayune, MS - 394665575 |
| Business Phone Number: | 6013589765 |
| Business Fax Number: | |
| Mailing Address: | 146 Highland Pkwy, PICAYUNE |
| State: | MS |
| Postal Code: | 394665575 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/09/2015 |
| NPI Last Update Date: | 02/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | R881222 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |