Provider Demographics
NPI:1821268897
Name:BRUNER, KIM JANE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:JANE
Last Name:BRUNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOCKHEED MARTIN
Mailing Address - Street 2:86 S COBB DR
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30063-0001
Mailing Address - Country:US
Mailing Address - Phone:770-494-4131
Mailing Address - Fax:770-494-7490
Practice Address - Street 1:LOCKHEED MARTIN
Practice Address - Street 2:86 S COBB DR
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30063-0001
Practice Address - Country:US
Practice Address - Phone:770-494-4131
Practice Address - Fax:770-494-7490
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR047850363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health