Kelli Bundza, AT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL 3002 Issued in FL

Practice address

5321 Georgia Peach Ave
Port Orange, FL 32128-7534

Phone

(386) 852-4137

NPI assigned

Jul 18, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelli Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405641600000",
    "number": "1477960771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5321 GEORGIA PEACH AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321287534",
            "telephone_number": "386-852-4137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5321 GEORGIA PEACH AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321287534",
            "telephone_number": "386-852-4137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNDZA",
        "first_name": "KELLI",
        "credential": "AT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-18",
        "last_updated": "2014-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL 3002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "JOHNSON",
            "credential": "AT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lanika M. Buchanan, ND, AP
• Sandra Buchanan, MD
• Brooke Raechelle Bugni, LMHC
• Laurie Ann Bukowski, DC
• Ann Bullock
• John Bunnell, M.D.
• Lyndsey Clairday Burd
• Margaret Burg, ARNP
• Ronald Lee Burgess II, DC, ND
• Tina Marie Burgess, ARNP

• Athletic Trainer in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.