Provider Demographics
NPI:1134150303
Name:BRUNER, SHIRLEY D (NP-C)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:D
Last Name:BRUNER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:D
Other - Last Name:HOOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1803 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2547
Mailing Address - Country:US
Mailing Address - Phone:812-704-9182
Mailing Address - Fax:
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:502-287-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004301363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78014008Medicaid
KY0957301Medicare PIN
IN219370BMedicare PIN
KY78014008Medicaid