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NPI Code Detail

MEDICARE: TRACEY LYNN BRUNER FNP

MEDICARE: TRACEY LYNN BRUNER FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1093319006TX
2363LF0000XFamily Nurse Practitioner1015649TX

General Provider Information

NPI Number : 1093319006
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY LYNN BRUNER FNP
Provider Business Mailing Address
First Line : 1600 S HENDERSON BLVD
Second Line :
City : KILGORE
State : TX
Zip : 75662-3518
Country : US
Telephone Number : 903-475-3474
Fax Number : 903-367-0300
Provider Business Practice Location Address
First Line : 1600 S HENDERSON BLVD
Second Line :
City : KILGORE
State : TX
Zip : 75662-3518
Country : US
Telephone Number : 903-475-3474
Fax Number : 903-367-0300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2020
Last Update Date : 10/14/2024

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