Provider Demographics
NPI:1558072439
Name:BRUNSON, CARRIE ELLEN (NP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELLEN
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ELLEN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-4726
Mailing Address - Country:US
Mailing Address - Phone:254-298-7137
Mailing Address - Fax:
Practice Address - Street 1:304 S 22ND ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-4726
Practice Address - Country:US
Practice Address - Phone:254-298-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089880363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health