Provider Demographics
NPI:1477785798
Name:BRUNSON, KIMBERLY G (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:G
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
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 70
Mailing Address - Street 2:
Mailing Address - City:HODGE
Mailing Address - State:LA
Mailing Address - Zip Code:71247-0070
Mailing Address - Country:US
Mailing Address - Phone:318-259-1100
Mailing Address - Fax:318-259-1333
Practice Address - Street 1:244 BOND ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-5334
Practice Address - Country:US
Practice Address - Phone:318-259-1100
Practice Address - Fax:318-259-1333
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-185698363L00000X
LA107826-05919363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1807192Medicaid
LA3B388DF59Medicare PIN