Provider Demographics
NPI:1760798508
Name:BRUNE SHRUM, KIMBERLY A (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BRUNE SHRUM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:BRUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2103 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4511
Mailing Address - Country:US
Mailing Address - Phone:850-763-8000
Mailing Address - Fax:850-785-1122
Practice Address - Street 1:222 S WOODS MILL RD STE 500N
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3640
Practice Address - Country:US
Practice Address - Phone:314-205-6699
Practice Address - Fax:314-590-5923
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9353850363L00000X
MO2010016428363LA2200X
IL209.008308363LA2200X
MO2019001247363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner