MEDICARE: QUALITY CARE CENTER

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
1	363LF0000X	Family Nurse Practitioner	AP05919	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699058354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY CARE CENTER

Provider Business Mailing Address
First Line	:	103 WATTS ST
Second Line	:
City	:	JONESBORO
State	:	LA
Zip	:	71251-2053
Country	:	US
Telephone Number	:	318-259-1511
Fax Number	:	318-259-9979

Provider Business Practice Location Address
First Line	:	103 WATTS ST
Second Line	:
City	:	JONESBORO
State	:	LA
Zip	:	71251-2053
Country	:	US
Telephone Number	:	318-259-1511
Fax Number	:	318-259-9979

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	MRS. KIMBERLY LYNN BRUNSON
Credential	:	FNP
Telephone Number	:	318-259-1511

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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Directions to “QUALITY CARE CENTER ” Practice Location

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