Provider Demographics
NPI:1982825550
Name:BRUNETT, LANA CLIETT (APRN, FNP, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:CLIETT
Last Name:BRUNETT
Suffix:
Gender:F
Credentials:APRN, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 FM 3370
Mailing Address - Street 2:
Mailing Address - City:AQUILLA
Mailing Address - State:TX
Mailing Address - Zip Code:76622
Mailing Address - Country:US
Mailing Address - Phone:254-695-7896
Mailing Address - Fax:
Practice Address - Street 1:3501 N 19TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-2097
Practice Address - Country:US
Practice Address - Phone:254-745-5117
Practice Address - Fax:254-296-5935
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658403363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX05546OtherPRESCRIPTION ID NUMBER