Provider Demographics
NPI:1801118229
Name:BRUNSON, COURTNEY LEIGH (NP-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEIGH
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MANGHAM
Mailing Address - State:LA
Mailing Address - Zip Code:71259-5055
Mailing Address - Country:US
Mailing Address - Phone:985-320-1846
Mailing Address - Fax:
Practice Address - Street 1:2869 NEW MONROE RD
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-1429
Practice Address - Country:US
Practice Address - Phone:985-320-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN121762163W00000X
LANP09315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1801118229Medicaid