Provider Demographics
NPI:1699181792
Name:BRUNACINI, KEVIN TODD (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TODD
Last Name:BRUNACINI
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6267 FINCHLEY RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-8591
Mailing Address - Country:US
Mailing Address - Phone:937-205-6529
Mailing Address - Fax:
Practice Address - Street 1:6267 FINCHLEY RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-8591
Practice Address - Country:US
Practice Address - Phone:937-205-6529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 174H00000X
KY3008539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator