Provider Demographics
NPI:1013082205
Name:BRUNER, TARA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:BRUNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5922
Mailing Address - Country:US
Mailing Address - Phone:405-650-8354
Mailing Address - Fax:
Practice Address - Street 1:205 EAST RACE AVENUE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4329
Practice Address - Country:US
Practice Address - Phone:501-279-9000
Practice Address - Fax:501-279-9011
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-355363AM0700X
OKPA1498363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical