Provider Demographics
NPI:1518959444
Name:BRUNSTING, KIMBERLY COKER (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:COKER
Last Name:BRUNSTING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 CHAMPIONS BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6471
Mailing Address - Country:US
Mailing Address - Phone:334-528-5959
Mailing Address - Fax:334-528-5899
Practice Address - Street 1:2375 CHAMPIONS BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6471
Practice Address - Country:US
Practice Address - Phone:334-528-5959
Practice Address - Fax:334-528-5899
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-078166363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00048664OtherRAILROAD MEDICARE
TN3901756Medicaid
TN4084805OtherBCBS
TN10071082OtherAMERIGROUP COMMUNITY CARE
KY7100000620OtherKY MEDICAID
TNP00048664OtherRAILROAD MEDICARE
KY7100000620OtherKY MEDICAID