Provider Demographics
NPI:1558938654
Name:BRUNER, REBECCA (PMHNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BRUNER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CODELL DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1177
Mailing Address - Country:US
Mailing Address - Phone:859-800-0301
Mailing Address - Fax:
Practice Address - Street 1:5807 HARRODS GLEN DR
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7650
Practice Address - Country:US
Practice Address - Phone:812-207-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1128632163W00000X
KY3016213363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse